Reasons for non-attendance in cervical cancer screening programmes: an application of the Integrated Model for Behavioural Change.

Adherence to the Dutch cervical cancer-screening programme continues to fall below objectives. The aim was to analyse determinants of (non) attendance. A computer-assisted telephone survey based on the I-change model was used to collect data on determinants of (non) participation in 200 (non) attendees of the screening programme in 2001. Non-attendees experienced more affective disadvantages of screening, were more insecure and afraid of smear taking, expected to experience more feelings of shame and were more insecure and anxious about the result. Attendees perceived more positive social influence, had more positive role models, talked more often with others about screening and perceived a more positive norm. Many misconceptions still exist among both attendees and non-attendees. In order to motivate Dutch women to participate in the screening programme, they need to be convinced that the advantages of screening outweigh the disadvantages. Especially affective disadvantages need to be targeted, perceived social norms upgraded and the level of self-efficacy should be raised. In addition, awareness of the risk of cervical cancer and the potentials of screening need to be optimized and misconceptions minimized. To improve the I-change model, further research is recommended to explore the relationship between ambivalence and intention