Social Patterning of Screening Uptake and the Impact of Facilitating Informed Choices: Psychological and Ethical Analyses

Screening for unsuspected disease has both possible benefits and harms for those who participate. Historically the benefits of participation have been emphasized to maximize uptake reflecting a public health approach to policy; currently policy is moving towards an informed choice approach involving giving information about both benefits and harms of participation. However, no research has been conducted to evaluate the impact on health of an informed choice policy. Using psychological models, the first aim of this study was to describe an explanatory framework for variation in screening uptake and to apply this framework to assess the impact of informed choices in screening. The second aim was to evaluate ethically that impact. Data from a general population survey (n = 300) of beliefs and attitudes towards participation in diabetes screening indicated that greater orientation to the present is associated with greater social deprivation and lower expectation of participation in screening. The results inform an explanatory framework of social patterning of screening in which greater orientation to the present focuses attention on the disadvantages of screening, which tend to be immediate, thereby reducing participation. This framework suggests that an informed choice policy, by increasing the salience of possible harms of screening, might reduce uptake of screening more in those who are more deprived and orientated to the present. This possibility gives rise to an apparent dilemma where an ethical decision must be made between greater choice and avoiding health inequality. Philosophical perspectives on choice and inequality are used to point to some of the complexities in assessing whether there really is such a dilemma and if so how it should be resolved. The paper concludes with a discussion of the ethics of paternalism

Temporal perspective and parental intention to accept the human papillomavirus vaccination for their daughter

Objective. A school-based vaccination programme to prevent infection with the human papillomavirus (HPV), the virus that causes cervical cancer, began in October 2008 in England. The present study evaluated the role of temporal perspective in the formation of attitudes and intentions towards the vaccine. Design: A cross-sectional correlational survey of 245 parents of 11-12-year-old girls. Methods: Parents read a passage about the HPV vaccine containing information about benefits and concerns parents might have about the vaccine. They then completed a thought listing task and measures of attitude, vaccine efficacy, anticipated regret, intention, and consideration of future consequences. Results: Parents with higher consideration of future consequences generated more positive relative to negative thoughts, held more positive attitudes, higher response efficacy, reported higher anticipated regret about not vaccinating their daughters and held more positive intentions. Mediation analyses suggested that the influence of thoughts generated on intention to vaccinate was partially mediated by attitude, perceived vaccine efficacy, and anticipated regret if the vaccine were not taken up. Conclusion. Messages emphasizing efficacy of vaccination and anticipated regret are likely to promote vaccination uptake. © 2010 The British Psychological Society