Spiralling vulnerabilities: Understanding the cervical screening behaviours of women over 50 living in the west of Ireland

Abstract

In Ireland, 1 in 4 women over 50 do not attend cervical screening (CervicalCheck Report, 2017a). The aim in this dissertation is to understand the cervical screening behaviours of women over 50. Located within the interpretive paradigm, the methodological approach adopted in this qualitative study is constructivist grounded theory.

The aim of the study was not to generate generalisable findings but to develop a theory in a limited context (the west of Ireland), of a limited phenomenon (cervical screening behaviour in women over 50 years of age). Data collection involved 74 in-depth semi-structured interviews with 32 participants, representing various ethnic and social groups of the Irish population, which included women who are up to date with screening (n = 16), women who are not up to date (n = 11), and those who have never had a cervical screening test (n = 5).

This study provides a theory of ‘Spiralling Vulnerabilities’, which illuminates our understanding of the cervical screening behaviours of women over 50 years. Underpinning the theory is a process of how women make the decision to attend cervical screening, conceptualised as self-positioning process, and describes women’s Overcoming Resistance.

The key findings reported that all participants engaged in a self-positioning process to decide if they were ‘at risk’ of developing cervical cancer or suffering psychological distress. They also emphasised the important role of ‘nudges’ to help prompt attendance among those who engaged in cervical screening. Participants who never engaged in the cervical screening programme needed improvements in the service to overcome their resistance towards cervical screening; Offering HPV self-testing was a turning point for women who seemed entrenched in their decision not to attend for a cervical screening test. The contextual and social possibilities of resistance to cervical screening drew attention to the role the Church and Irish society in the 1960s and 1970s that caused Irish-born participants to struggle with their sexual selves. In May 2018, while conducting the 18th interview, the cervical screening scandal occurred in Ireland. This allowed exploration of the cervical screening scandal on participants’ cervical screening behaviour. As a result of the cervical screening scandal, participants distrusted CervicalCheck. Unrealistic expectations of the sensitivity of cytology testing caused feelings of loss of trust in all Health Service Executive (HSE) services and healthcare professionals, and participants became increasingly cynical about the culture of paternalism and the history of cover-up in Irish women’s healthcare.

These findings have informed implications for practice and further research for healthcare professionals and policymakers in CervicalCheck and considerations for healthcare professionals in the space of women’s healthcare.