The four study groups differed in age, educational level, and whether or not this was their first smear test (). We controlled for these three variables when assessing differences in emotional outcomes between the groups (). In addition, we controlled for centre, although it was unrelated to any of the outcome variables in the study.
Demographic and clinical characteristics of women given results of cervical smear and human papillomavirus (HPV) tests. Values are numbers (percentages) unless stated otherwise
Emotional outcomes after receipt of results of smear test among women tested or not tested for human papillomavirus (HPV). Values are adjusted means (SE)
Analysis of covariance (with age, education, centre, and smear history as covariates) showed that the groups differed significantly in anxiety (F3,1218 = 4.44, P = 0.004), distress (F3,1271 = 5.37, P = 0.001), and concern (F3,1280 = 242.44, P < 0.001). Planned contrasts confirmed two of the three research hypotheses. Firstly, the group with normal test results had significantly less anxiety (t = 2.19, P = 0.028), distress (t = 2.06, P = 0.040), and concern (t = 24.64, P < 0.001) than the three groups with abnormal test results, taken together. Secondly, the HPV positive group had significantly higher anxiety (t = 3.11, P = 0.002), distress (t = 3.252, P = 0.001), and concern (t = 13.391, P < 0.001) than the other three groups taken together. The third hypothesis was not supported: women who had abnormal smear test results who were HPV negative did not have lower anxiety (t = 0.064, P = 0.949), distress (t = 0.827, P = 0.409), or concern (t = 0.852, P = 0.394) than women who had abnormal smear test results but were not tested for HPV. Although this third hypothesis was not supported, a trend analysis showed a significant linear trend for all mean scores for all three outcome measures: anxiety (F1,1218 = 12.73; P = 0.0003), emotional distress (F1,1271 = 15.46; P = 0.00009), and concern (F1,1280 = 561.94; P < 0.00001) when the groups were ordered as presented in , in ascending order of risk of developing cervical cancer.
All groups viewed cervical cancer as extremely serious (), but they differed in their perceptions of the risk of developing it (F3,1324 = 25.51; P < 0.0001): women who were HPV positive perceived their risks as greater than all other groups (Tukey post hoc contrast tests). Perceptions of risk also followed a significant linear trend (F1,1324 = 76.08; P < 0.0001) when the groups were ordered in ascending order of actual risk.
Perceptions of the threat of cervical cancer of women given different results of cervical smear and human papillomavirus (HPV) tests. Values are means (SEs) unless otherwise stated
Forty one per cent of women stated they were unaware of what HPV was. This was more common in women not tested for HPV than in those tested. In all groups, women who were familiar with HPV perceived HPV infection as important in causing cervical cancer, although those with an abnormal result who had not been tested for HPV perceived it as less important than did all other groups (F3,778 = 3.42, P = 0.017). Although most of the women tested for human papillomavirus knew what HPV was, 25% (95% confidence interval 21% to 28%) of HPV positive women stated that they did not know what it was.
The groups also differed in their understanding of their results (χ2 = 194.13, df = 12, P < 0.001; ). Compared with women receiving normal results, those receiving abnormal results were less likely to think their result meant they definitely did not have, or were very unlikely to, have cervical cancer. Women with abnormal results, whether tested for HPV or not, were less likely to know what their results meant than did women receiving a normal result (χ2 = 77.96, df = 3, P < 0.001), with 26% (22% to 29%) of those who tested HPV positive stating that they did not know what this meant for their health.
We entered all variables in the linear multiple regression, apart from perceived importance of human papillomavirus in causing cervical cancer (as 25% of women failed to respond to this item). Of these, only three variables independently predicted anxiety (R2 = 0.103, adjusted R2 = 0.084, P < 0.001): age, with younger age being associated with higher anxiety (β = -0.11, P = 0.033); perceived risk of developing cervical cancer (β = 0.17, P < 0.001); and reporting not knowing the meaning of the smear test result (β = 0.17, P = 0.001). Figures and show the associations between anxiety and the two strongest predictors. Two of these three variables were also predictive of distress (R2 = 0.073, adjusted R2 = 0.068, P < 0.001) and concern (R2 = 0.138, adjusted R2 = 0.133, P < 0.001): perceived risk of developing cervical cancer (distress β = 0.20, P < 0.001; concern β = 0.24, P < 0.001) and reporting not knowing the meaning of the result (distress β = 0.15, P < 0.001; concern β = 0.24, P < 0.001).
Associations between state anxiety and perceived risk of developing cervical cancer (measured on seven point scale) in women with an abnormal smear result and positive test results for human papillomavirus
Associations between state anxiety and understanding of smear test results in women with an abnormal smear result and test results positive for human papillomavirus