An intervention to increase attendance rates for cervical screening: The impact of implementation intentions and anticipated regret

Objectives: There is substantial evidence that mortality from cervical cancer can be reduced by regular attendance for a cervical smear test. This study examined the physical and psychological factors that predict attendance for cervical screening, using the Theory of Planned Behaviour (TPB), in a sample of over 1000 women aged between 25 and 60 years. The study examined the impact of anticipated regret on attendance for a smear and evaluated the effectiveness of an intervention that encourages women to form implementation intentions as a mechanism to increase uptake rates. Methods: Participants were randomly selected (N= 3000) from the ICSP database of all women aged between 25 and 60 in the Mid-Western Health Board region and sent the study questionnaire and a letter inviting them to attend for a smear test. Attendance was measured by computerised records sent from the cytology laboratories. Data was collected on the Theory of Planned Behaviour (TPB) variables including anticipated regret. Half of the sample was asked to specify the details of their attendance (i.e. form implementation intentions) in their questionnaires. Results: The questionnaire response rate was 41%. Overall attendance for a smear test was poor (17%). The TPB variables and anticipated regret were significant predictors of intentions to attend. The intervention was effective, with women assigned to the implementation intention condition significantly more likely to attend for a smear than those who did not (32% versus 25%) (c2 = 5.55, df= 1,p = 0.02). Conclusions: The results of this study demonstrate that a simple intervention was effective in increasing attendance for a smear test and has implications for future cancer screening programmes.