Dr Emily McBride is a Senior Research Fellow and Health Psychologist (HCPC registered) in the Department of Behavioural Science and Health at UCL. She has a keen interest in generating impact through influencing public policy and health practice. Emily works closely with senior policy teams in the UK Department of Health and Social Care, Public Health England, and NHS England. She is also the Policy Lead for the British Psychological Society Division of Health Committee. From 2017 to 2020, she sat on the National HPV Primary Screening Pilot Committee where she co-represented the psychological evaluation of HPV primary cervical cancer screening.
It has been over a year since HPV primary cervical screening was fully implemented in England – a policy which is estimated to save around 500 lives per year. This is fantastic news for cancer prevention. Together with the HPV vaccination programme, it helps bring us one step closer to eliminating cervical cancer.
From the perspective of the screening participant, the main novelty of HPV primary screening is that everyone who attends gets tested for HPV and receives an HPV-positive or HPV-negative result. As HPV is very common, this means that each year in England, over 400,000 people now receive an HPV-positive result.
Given that HPV is known to cause cervical cancer and is sexually transmitted, we were interested in how those attending HPV primary screening might interpret and react to receiving an HPV-positive result. Especially given that the majority who test HPV-positive do not have abnormal cells (also known as normal cytology) and therefore only receive their result via mailed letter, with no follow-up clinical contact. This means that the routine information they get about HPV is contained in their result letter and information leaflet. Developing patient materials which effectively communicate test result information is therefore a key priority for the NHS cervical screening programme.
Over the last few years, our research has examined psychological aspects of testing HPV-positive, aimed at informing evidence-based patient communication materials. We know from one of our previous studies that people who test HPV-positive are more likely to experience clinically significant (very high) anxiety. However, we were unable to determine the reasons for this adverse psychological reaction, which is critical for determining what areas to target to reduce anxiety.
Therefore, in our most recent paper on this topic, published in Annals of Behavioral Medicine, we assessed beliefs about HPV among people testing HPV-positive, and explored whether they formed distinct psychological ‘profiles’. We investigated how certain profiles of beliefs might influence anxiety levels shortly after receiving an HPV-positive result at routine screening.
What did our research involve?
We recruited 646 participants who completed a psychological survey assessing their mood and beliefs about HPV. This was shortly after they had received an HPV-positive result with no abnormal cells (normal cytology) at routine HPV primary cervical screening in England. We also asked people to report whether they had ongoing mental health issues, like an anxiety disorder, so that we could adjust for this in our analyses along with other sociodemographic factors. Our questions in the survey were guided by a widely used and evidence-based health psychology theory called The Common-Sense Model of Self-Regulation.
What did we find?
Participants testing HPV-positive had one of three distinct profiles of HPV-related beliefs. These psychological profiles helped to explain the reasons for individual differences in anxiety.
The three identified profiles were:
- Adaptive (Helpful) Beliefs
- Those with this belief profile accounted for around 38% of our sample.
- They had the lowest anxiety score, which was within the normal population range.
- Notably, they reported that HPV had very little impact on their life (low perceived consequences), suggesting that cervical cancer or sexual concerns were unlikely.
- Their general beliefs appeared to reflect a relatively accurate interpretation of their result. They thought that HPV would last for a moderate time period; believed that HPV did not have symptoms; and expressed low-to-moderate concern.
- Negative Beliefs
- People with negative beliefs accounted for around 45% of our sample.
- They had markedly higher anxiety than those with adaptive beliefs, with a mean anxiety score which was clinically significant.
- In contrast with the adaptive beliefs group, they believed that HPV had a greater impact on their life and that it would last for longer.
- They were more concerned about HPV and expressed that HPV affected them emotionally.
- They also reported a lower understanding of HPV when compared with those who held adaptive beliefs.
- Negative Somatic Beliefs
- A smaller proportion of the sample (16%) had negative somatic beliefs.
- They had high anxiety scores, similar to those in the negative beliefs group (profile 2).
- Their beliefs about HPV were also very similar to the negative beliefs group.
- Interestingly, however, they believed that HPV was responsible for causing other symptoms that they were experiencing.
- The three most endorsed symptoms that they believed HPV was responsible for were discharge (50%), unusual bleeding (32%), and pain during sex (29%).
- Given that HPV is asymptomatic and participants in this study had no abnormal cells (normal cytology), these beliefs about symptoms were almost certainly due to misattributions.
What does this mean for cervical screening?
Our study was the first to identify distinct psychological profiles among people testing positive for HPV. We hope that our findings can be used by screening health care professionals, policymakers, and third sector organisations to improve communication of HPV results.
We recommend that targeted messages are used in patient communications (e.g., result letters or leaflets) to help address the negative beliefs we identified. This will help to alleviate the concerns of the most highly anxious group.
Patient and public-facing materials could, for example, provide supportive information on potential consequences of HPV (e.g., cancer risk and sexual relationships) and emphasise that HPV is asymptomatic. Online HPV self-help interventions could be hosted by NHS or third sector websites to improve patient understanding of HPV and provide additional support.
The views expressed are those of the author. Posting of the blog does not signify that the Cancer Prevention Group endorse those views or opinions.
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