Exploring reasons for variations in anxiety after testing positive for human papillomavirus with normal cytology: a comparative qualitative study

• Published in: Psycho-oncology (Chichester, England) England), 2021-01, Vol.30 (1), p.84-92
• Main Authors: McBride, Emily, Marlow, Laura A. V., Bennett, Kirsty F., Stearns, Selma, Waller, Jo
• Format: Article
• Language: English
• Subjects: Adult; Anxiety; Anxiety - etiology; Anxiety - psychology; Anxiety disorders; Attribution; Behavior change; Cancer; Cellular biology; Cervical cancer; Cervical Intraepithelial Neoplasia - prevention & control; Cervical Intraepithelial Neoplasia - psychology; cervical screening; Cognitive-behavioral factors; Communication; cytology; Early Detection of Cancer; Emotions; Fear & phobias; Female; Fertility; Health behavior; HPV; Human papillomavirus; Humans; Infidelity; Locus of control; Mass Screening - psychology; Medical screening; Mental health; Middle Aged; oncology; Papillomaviridae - isolation & purification; Papillomavirus Infections - prevention & control; Papillomavirus Infections - psychology; Patient communication; Physiology; psychology; psycho‐oncology; Qualitative research; Stress, Psychological - etiology; Surveys and Questionnaires; Test anxiety; Uterine Cervical Neoplasms - prevention & control; Uterine Cervical Neoplasms - psychology; Uterine Cervical Neoplasms - virology; Vaginal Smears - psychology; Women; Womens health; Worry
• ISSN: 1057-9249; 1099-1611
• DOI: 10.1002/pon.5540

Objective To explore reasons for variations in anxiety in women testing positive for human papillomavirus (HPV) with normal cytology at routine HPV primary cervical cancer screening. Methods In‐depth interviews were conducted with 30 women who had tested HPV‐positive with normal cytology, including 15 with low‐to‐normal anxiety and 15 with high anxiety. Data were analysed using Framework Analysis to compare themes between low and high anxiety groups. Results Several HPV‐related themes were shared across anxiety groups, but only highly anxious women expressed fear and worry, fatalistic cognitions about cancer, fertility‐related cognitions, adverse physiological responses and changes in health behaviour(s). In comparison to those with low anxiety, women with high anxiety more strongly voiced cognitions about the 12‐month wait for follow‐up screening, relationship infidelity, a lower internal locus of control and HPV‐related symptom attributions. Conclusions Receiving an HPV‐positive with normal cytology result related to various emotional, cognitive, behavioural and physiological responses; some of which were specific to, or more pronounced in, women with high anxiety. If our observations are confirmed in hypothesis‐driven quantitative studies, the identification of distinct themes relevant to women experiencing high anxiety can inform targeted patient communications and HPV primary screening implementation policy. Highlights To our knowledge, this is the first qualitative study to explore anxiety in women testing human papillomavirus (HPV)‐positive with normal cytology at routine HPV primary screening. Our comparative qualitative design allowed thematic nuances to emerge between women who had experienced low versus high anxiety following their result. Only highly anxious women expressed fear and worry, fatalistic cognitions about cancer, fertility‐related cognitions, adverse physiological responses and changes in health behaviour(s). Highly anxious women also more strongly voiced cognitions about the 12‐month wait for follow‐up screen, reltionship infidelity, a lower internal locus of control and HPV‐related symptom attributions. These distinct themes can be used to minimise unnecessary anxiety through the development of evidence‐based patient communications at HPV primary screening.