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Colorectal cancer screening
Public understanding of cancer
Cervical cancer screening and prevention
Cancer Research UK post-doctoral fellowships

Promoting action in screening participation (PRO-ACT)

PRO-ACT focuses on the gap between intention and subsequent behaviour in the context of colorectal cancer screening. We examine reasons for the intention-behaviour gap by looking at the measurement of intentions, the circumstances under which intentions are formed and practical barriers which prevent people from participating in screening. Our work includes laboratory-and community-based projects as well as surveys and interventions.

Our laboratory-based research principally targets processes involved in intention formation and the measurement of intentions. It includes direct manipulation of the contexts in which intentions are formed and studies into the way people process information about Bowel Cancer Screening.

Our community-based research aims to develop novel ways of engaging with hard-to-reach populations which might be missed out in laboratory-based and survey research. We are actively seeking partnership with local screening centres and health promotion experts to test the effectiveness of information materials and capture attitudes of different ethnic groups towards the NHS Bowel Cancer Screening Programme at local community groups.

The overall aim of PRO-ACT is to translate the findings from all areas of PRO-ACT into interventions which will help to promote intention-translation into action with the aim of increasing participation rates for colorectal cancer screening.

Key contacts: Dr Christian von Wagner, Dr Siu Hing Lo, Prof Jane Wardle

Collaborators: Prof Wendy Atkin, Prof Chris Brewin, Prof Paschal Sheeran, Dr Sandra Rainbow, Prof Stephen Halloran

Key publications:
von Wagner, C., Good, A., Smith, S., Wardle, J. Responses to procedural information about colorectal screening using Faecal Occult Blood testing: the role of consideration of future consequences. Health Expectations, (in press) (view abstract)

von Wagner, C., Good, A., Whitaker, K. L., Wardle, J. Psychosocial Determinants of Socioeconomic Inequalities in Cancer Screening Participation: A Conceptual Framework. Epidemiologic Reviews, (in press) (view abstract)

Whitaker, K. L., Good, A., Miles, A., Robb, K. A., Wardle, J., von Wagner, C. Socioeconomic inequalities in colorectal cancer screening uptake: does time perspective play a role? Health Psychology, (in press) (view abstract)

von Wagner, C., Baio, G., Raine, R., Snowball, J., Morris, S., Atkin, W., Obichere, A., Handley, G., Logan, R. F., Rainbow, S., Smith, S., Halloran, S., Wardle, J. Inequalities in participation in an organised national colorectal cancer screening programme: results from the first 2.6 million invitations in England. International Journal of Epidemiology 40, 2011, 712-718 (view abstract)

von Wagner, C., Semmler, C., Power, E., Good, A. What matters when deciding whether to participate in colorectal cancer screening? The moderating role of time perspective. Journal of Applied Biobehavioral Research 15, 2010, 20-30 (view abstract)

Power, E., Miles, A., von Wagner, C., Robb, K., Wardle, J. Uptake of colorectal cancer screening: system, provider and individual factors and strategies to improve participation. Future Oncology 5(9), 2009, 1371-1388 (view abstract)

von Wagner, C., Good, A., Wright, D., Rachet, B., Obichere, A., Bloom, S., Wardle, J. Inequalities in colorectal cancer screening participation in the first round of the national screening programme in England. British Journal of Cancer 101, 2009, S60-S63 (view abstract)

von Wagner, C., Semmler, C., Good, A., Wardle, J. Health literacy and self-efficacy for participating in colorectal cancer screening: the role of information processing. Patient Education and Counselling 75, 2009, 352-357 (view abstract)

The ASCEND project is an NIHR funded programme grant (PI Prof Rosalind Raine) which aims to increase uptake of the NHS Bowel Cancer Screening Programme, particularly among socially deprived groups. The research consists of four workstreams (WSs): WS1 will allow us to explore the psycho-social and cultural determinants of low uptake of the faecal occult blood test (FOBt) through a series of focus groups. WS2 will develop 3 novel interventions in collaboration with people from the community and former bowel cancer patients. These interventions will include 1) an amended invitation incorporating a GP recommendation, in combination with an enhanced reminder letter 2) the production of a 'gist' based information sheet and 3) the development of a narrative style information leaflet. WS3 will use an experimental design to examine whether each individual intervention reduces inequalities without reducing uptake in any socioeconomic group. WS4 will combine the most cost-effective interventions from WS3 and test the combined intervention nationally.

Key contacts: Dr Christian von Wagner, Dr Gemma Vart, Dr Lesley McGregor, Sam Smith, Prof Jane Wardle

Collaborators: Prof Rosalind Raine, Mary Thomas, Dr Cecily Palmer, Prof Wendy Atkin, Dr Ines Kralj-Hans, Dr Clare Monk, Dr Allan Hackshaw, Prof Stephen Duffy, Patrick Fuller, Prof Stephen Halloran, Dr Graham Handley, Prof Richard Logan, Prof Stephen Morris, Dr Austin Obichere, Dr Sandra Rainbow, Dr Stephen Smith, Neil Stubbs

Flexible sigmoidoscopy screening
Working closely with our colleagues in CR-UK (Prof Wendy Atkin, Dr Rob Edwards, Prof Jack Cuzick), we have taken a lead in research into the psychological aspects of colorectal screening.

Following the positive results of a multicentre randomised controlled trial of flexible-sigmoidoscopy (FS) screening (PI Professor Atkin ) it was announced by the government that FS screening will be implemented. Although the details are still being worked on, we have begun to look at ways in which FS screening could be rolled out using specially trained nurses.

With Professor Atkin , we have completed a Keymed-funded pilot study of a population-based call system for FS, using a nurse-led screening programme. We developed new invitation materials which in pilot testing appear to achieve excellent uptake rates. We have also completed a larger Department of Health funded nurse-led feasibility study in a socioeconomic and ethnically diverse area of London. Findings showed acceptable levels of uptake but further research is needed to address socioeconomic disparities in uptake.

Key contacts: Dr Katie Robb, Dr Emily Power, Prof Jane Wardle

Collaborators: Prof Wendy Atkin, Dr Rob Edwards, Prof Jack Cuzick

Key publications:
Robb, K. A., Smith, S. G., Power, E., Kralj-Hans, I., Vance, M., Wardle, J., Atkin, W. Nurses' experiences of a colorectal cancer screening pilot. British Journal of Nursing 20, 2011, 210-218 (view abstract)

Robb, K. A., Power, E., Kralj-Hans, I., Atkin, W. S., Wardle, J. The impact of individually-tailored lifestyle advice in the colorectal cancer screening context: a randomised pilot study in North-West London. Preventive Medicine 51, 2010, 505-508 (view abstract)

Atkin, W. S., Edwards, R., Kralj-Hans, I., Wooldrage, K., Hart, A. R., Northover, J. M. A., Parkin, D. M., Wardle, J., Duffy, S. W., Cuzick, J., UK Flexible Sigmoidoscopy Trial. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 375(9726), 2010, 1624-1633 (view abstract)

Atkin, W., Wardle, J., Kralj-Hans, I., Duffy, S. Flexible sigmoidoscopy to prevent colorectal cancer Reply. Lancet 376(9744), 2010, 871-872 (view abstract)

Robb, K., Power, E., Kralj-Hans, I., Edwards, R., Vance, M., Atkin, W., Wardle, J. (2010). Flexible sigmoidoscopy screening for colorectal cancer: uptake in a population-based pilot programme. Journal of Medical Screening 17, 2010, 75-78 (view abstract)

Wardle, J., Atkin, W. Colorectal cancer prevention through screening: population acceptance of flexible sigmoidoscopy. Journal of Medical Screening 17, 2010, 56-57 (view abstract)

Austin, K. L., Power, E., Solarin, I., Atkin, W. S., Wardle, J., Robb, K. Perceived barriers to flexible sigmoidoscopy screening for colorectal cancer among UK ethnic minority groups: a qualitative study. Journal of Medical Screening 16, 2009, 174-179 (view abstract)

Miles, A., Atkin, W. S., Kralj-Hans, I., Wardle, J. The psychological impact of being offered surveillance colonoscopy following attendance at colorectal screening using flexible sigmoidoscopy. Journal of Medical Screening 16, 2009, 124-130 (view abstract)

Power, E., Van Jaarsveld, C., McCaffery, K., Miles, A., Atkin, W., Wardle, J. Understanding intentions and action in colorectal cancer screening. Annals of Behavioral Medicine 35, 2008, 285-294 (view abstract)

Robb, K. A., Power, E., Atkin, W., Wardle, J. Ethnic differences in participation in flexible sigmoidoscopy screening in the UK. Journal of Medical Screening 15, 2008,130-136 (view abstract)

Robb KA, Solarin I, Power E, Atkin W, Wardle J. (2008) Attitudes to colorectal cancer screening among ethnic minority groups in the UK. BMC Public Health 25;2008;8:34 (view abstract)

Brotherstone H, Vance M, Edwards R, Miles A, Robb KA, Evans REC, Wardle J and Atkin W. Uptake of population-based flexible sigmoidoscopy screening for colorectal cancer: a nurse-led feasibility study. Journal of Medical Screening 14, 2007, 76-80 (view abstract)

Experiences of diagnostic, screening and surveillance bowel technologies
We are continuing our work with Prof Wendy Atkin, Prof Steve Halligan and others, into psychological assessments of new technologies for bowel cancer diagnosis, screening and surveillance. The advent of technologies such as faecal immunochemical testing (FIT) and CT colonography has led to increased interest of their use in these three areas. We are currently involved in three main projects in this area.

SIGGAR was an HTA funded pair of dual-arm randomised controlled trials assessing the effectiveness of CT Colonography for investigating symptoms of bowel cancer in older adults. We have recently published data comparing the experience of patients undergoing CT colonography with barium enema and are soon to publish data on the second trial comparing the experience of CT Colonography with colonoscopy. We have also published qualitative data from in-depth interviews with patients participating in SIGGAR.

We have also expanded our work on public perceptions of colonic investigations by investigating perceptions of CT colonography and colonoscopy. We have published a study of a series of quasi-experimental focus group sessions in which we explored information needs and preferences around each of these tests for investigating bowel symptoms. We have followed this up with an equivalent study consisting of a series of focus groups assessing perceptions of CT colonography and colonoscopy for screening. We will continue to work with a multidisciplinary team of epidemiologists, clinicians and health psychologists in order to investigate how CT colonography might be made more acceptable to individuals and estimate the uptake of a refined form of CT colonography if it were offered for screening.

FIT for Follow-Up
Research has shown that faecal immunochemical occult blood tests (FIT) are superior to the guaiac based faecal occult blood test (gFOBT), currently being used in the NHS Bowel Cancer Screening Programme, as they possess improved sensitivity and specificity. Therefore the purpose of the FIT for Follow-Up study (PI Prof Wendy Atkin ) is to establish whether FITs can be used as a safe, acceptable and cost-effective method of surveillance for people who are at increased risk of developing colorectal cancer because of a prior history of adenomas. Our research group are using both qualitative and quantitative methods to assess the acceptability of the FIT among individuals who are at low, intermediate and high risk of bowel cancer, some of whom will have previously had adenomas removed.

Key contacts: Dr Christian von Wagner, Alex Ghanouni, Dr Gemma Vart, Sam Smith, Harriet Bowyer, Prof Jane Wardle

Collaborators: Prof Wendy Atkin, Dr Ines Kralj-Hans, Dr Clare Monk, Prof Steve Halligan, Prof Steven Duffy, Prof Stephen Morris, Prof Stephen Halloran

Key publications:
von Wagner, C., Smith, S., Ghanouni, A., Power, E., Lilford, R., Morton, D., Dadswell, E., Atkin, W., Wardle, J. Patient acceptability of CT colonography compared with double contract barium enema: Results from a multicentre randomised controlled trial of symptomatic patients. European Radiology (in press) (view abstract)

von Wagner, C., Halligan, S., Atkin, W. S., Lilford, R. J., Morton, D., Wardle, J. Choosing between CT colonography and colonoscopy in the diagnostic context: a qualitative study of influences on patient preferences. Health Expectations 12(1), 2009 18-26 (view abstract)

Von Wagner, C., Knight, K., Halligan, S., Atkin, W., Lilford, R., Morton, D., Wardle, J. (2009). Patient experiences of colonoscopy, barium enema and CT colonography: a qualitative study. British Journal of Radiology 82(973), 2009, 13-19. (view abstract)

Our work on the public understanding of cancer has been strongly informed by our Cancer and Lay Models (CALM) project and by the National Awareness and Early Diagnosis Initiative (NAEDI). These strands have helped us to understand how the public conceptualises cancer, to quantify levels of public awareness of cancer risk factors and symptoms, and to identify important barriers to help-seeking.

Cancer and Lay Models (CALM)
The CALM study aims to characterise lay cancer representations and explore how public perceptions differ from medical understanding, with a view to promoting greater congruence between the two. To do this we have conducted a series of mixed-methods studies (e.g. cognitive mapping and similarity judgement techniques) with members of the public and healthcare professionals to explore analogies and metaphors for the development of cancer. These methods provided us with more detailed knowledge of people's understanding of the causal pathways that link cancer risk factors to cancer onset and gave us a greater insight into how people believe lifestyle factors may cause cancer. The ultimate aim of this research is to gain expert consensus about what would be a good model of cancer to present to people and to test the impact of 'expert' causal models on lay understanding of the disease.

Measuring Cancer Awareness
Along with colleagues at Kings College London and the University of Oxford we have designed and validated the Cancer Awareness Measure (CAM) . We have also designed and validated site-specific versions for ovarian, cervical, lung and colorectal cancer. Population-based surveys for the generic and site-specific CAMs have been conducted, which provided further evidence that public awareness of key signs and symptoms is low, particularly in men and those from low socioeconomic status groups. This strand of research has provided further impetus for the design and evaluation of interventions aimed at improving awareness of cancer signs and symptoms.

Key contacts: Dr Alice Simon, Dr Emily Power, Prof Jane Wardle

Collaborators: Dr Anne Miles, Prof Amanda Ramirez, Prof Una Macleod

Key publications:
Power, E., Simon, A., Juszczyk, D., Hiom, S., Wardle, J. Assessing awareness of colorectal cancer symptoms: Measure development and results from a population survey in the UK. BMC Cancer 11, 2011, 366. (view abstract)

Juszczyk, D., Simon, A., Waller, J., Wardle, J. Do the UK public realise that colorectal cancer is a common cancer? Colorectal Disease 13, 2011, 227-228 (view abstract)

Simon AE, Wardle J, Miles A. Is it time to change the stereotype of cancer: the expert view. Cancer Causes and Control 22, 2011, 135-40. (view abstract)

Simon, A. E., Waller, J., Robb, K., Wardle, J. (2010). Patient delay in presentation of possible cancer symptoms: the contribution of knowledge and attitudes in a population sample from the United kingdom. Cancer Epidemiology Biomarkers and Prevention 19, 2010, 2272-2277 (view abstract)

Robb, K., Wardle, J., Stubbings, S., Ramirez, A., Austoker, J., Macleod, U., Hiom, S., Waller, J. (2010). Ethnic disparities in knowledge of cancer screening programmes in the UK. Journal of Medical Screening 17, 2010, 125-131 (view abstract)

Miles A, Simon AE, Wardle J. Answering patient questions about the role lifestyle factors play in cancer onset and recurrence: what do health care professionals say? Journal of Health Psychology 15, 2010, 291-298 (view abstract)

Austoker, J., Bankhead, C., Forbes, L. J. L., Atkins, L., Martin, F., Robb, K., Wardle, J., Ramirez, A. J. Interventions to promote cancer awareness and early presentation: systematic review. British Journal of Cancer 101, 2009, S31-S39 (view abstract)

Robb, K., Stubbings, S., Ramirez, A., Macleod, U., Austoker, J., Waller, J., Hiom, S., Wardle, J. Public awareness of cancer in Britain: a population-based survey of adults. British Journal of Cancer 101(S2), 2009, S18-S23 (view abstract)

Stubbings, S., Robb, K., Waller, J., Ramirez, A., Austoker, J., Macleod, U., Hiom, S., Wardle, J. Development of a measurement tool to assess public awareness of cancer. British Journal of Cancer 101(S2), 2009, S13-S17 (view abstract)

Waller, J., Robb, K., Stubbings, S., Ramirez, A., Macleod, U., Austoker, J., Hiom, S., Wardle, J. Awareness of cancer symptoms and anticipated help-seeking among ethnic minority groups in England. British Journal of Cancer 101(S2), 2009, S24-S30 (view abstract)

Miles, A., Voorwinden, S., Mathews, A., Hoppitt, L. C., Wardle, J. Cancer fear and the interpretation of ambiguous information related to cancer. Cognition and Emotion 23, 2009, 701-713 (view abstract)

Health literacy
Since publishing a national survey of health literacy levels in the UK using an adapted version of the Test of Functional Health Literacy (TOFHLA), we have published a health literacy framework incorporating our knowledge of health psychology theory. In addition we have been working closely with Dr Michael Wolf and colleagues from Northwestern University on the association between health literacy levels and difficulty completing common health tasks. Additionally we are exploring the effect of health literacy on knowledge acquisition after exposure to cancer awareness messages. Our latest analysis used data from the Health Information and National Trends Survey (HINTS) to report on the association between confidence in understanding medical statistics and negative communicative experiences with primary healthcare providers.

Several researchers for the centre are members of the UK Health literacy group chaired by Prof Gillian Rowlands.

Key contacts: Dr Christian von Wagner, Sam Smith, Dr Alice Simon, Prof Jane Wardle

Collaborators: Prof Andrew Steptoe, Prof Gillian Rowlands, Dr Michael Wolf

Key publications:
Smith, S., Wolf, M. S., von Wagner, C. Socioeconomic status, statistical confidence and patient-provider communication: An analysis of the Health Information Trends Survey (Hints 2007). Journal of Health Communication 15, 2010, 169-185 (view abstract)

von Wagner, C., Steptoe, A., Wolf, M. S., Wardle, J. Health literacy and health actions: a review and framework from health psychology. Health Education and Behaviour 36(5), 2009, 860-877 (view abstract)

von Wagner, C., Semmler, C., Good, A., Wardle, J. Health literacy and self-efficacy for participating in colorectal cancer screening: the role of information processing. Patient Education and Counseling 75(3), 2009, 352-357 (view abstract)

Wagner, C., Knight, K., Steptoe, A., & Wardle, J. Functional health literacy and health-promoting behaviour in a national sample of British adults. Journal of Epidemiology and Community Health, 61, 2007, 1086-1090. (view abstract)

International Cancer Benchmarking Partnership - Module 2
Module 2 of the International Cancer Benchmarking Partnership (ICBP) is co-chaired by Prof Jane Wardle and Prof Amanda Ramirez . The project involves exploring differences in population awareness and beliefs about cancer across 12 members; New South Wales (Australia), Victoria (Australia), Sweden, Denmark, Norway, England, Northern Ireland, Wales, Alberta (Canada), British Columbia (Canada), Manitoba (Canada) and Ontario (Canada). We hope to explore the extent to which population cancer awareness and beliefs account for differences in survival between the members. This benchmarking project will enable us to monitor future trends and assess the impact of policy initiatives across large populations.

Key contacts: Dr Alice Simon, Prof Jane Wardle

Collaborators: Prof Amanda Ramirez

Developing an intervention to promote early presentation with gynaecological symptoms
Gynaecological cancers have a combined incidence in women second only to breast cancer in the UK. This NAEDI funded project aims to develop and trial an information leaflet detailing the symptoms of gynaecological cancers and encouraging women to present to their GP. Its aim is to increase awareness and reduce help seeking barriers, with the goal of reducing delay in presentation for gynaecological cancers.

The leaflet has been developed using psychological theory, health professional expertise and information from patients. The leaflet will be tested in three stages. Firstly the short term impact of the leaflet will be assessed in the general population using both questionnaire-based studies as well as in computer-based response time tasks. Secondly, both GPs and female patients' reactions to the leaflet and the feasibility of implementation of the leaflet will be assessed. Findings from both of these stages will inform changes to the intervention. Finally, a pilot study will be conducted across five GP practices in order to demonstrate the effect of the intervention on increased attendance at the GP with gynaecological symptoms. This will set the stage for a subsequent large-scale randomised controlled trial.

Key contacts: Dr Alice Simon, Dr Melanie Morris, Emily Boxell

Collaborators: Dr Marta Buszewicz, Dr Fiona Walter, Prof Usha Menon

Policy Research Unit
Professor Wardle has recently been appointed Deputy Director of the Policy Research Unit on Cancer awareness, screening and early diagnosis. This is a Department of Health funded unit which will provide specialist expertise in the area that is not otherwise readily available. The unit will provide research covering medium to long-term goals, as well as responding rapidly to undertake short term work where needed. The unit is directed by Prof Stephen Duffy and is spread across several world-class research groups and includes expertise ranging from clinical epidemiology, healthcare service evaluation to health psychology and behavioural medicine.

Key contacts: Prof Jane Wardle, Dr Jo Waller

High-risk human papillomavirus (HPV) types, transmitted during sexual intercourse, are known to be responsible for the oncogenic transformations that lead to cervical cancer.

Vaccination against HPV types 16 and 18 was introduced for all girls aged 12-13 years in September 2008. Prior to the start of the vaccine programme, we explored intended acceptance of HPV vaccination among mothers and identified potential concerns and barriers to acceptance. This work has drawn on both qualitative and quantitative methodologies and has gone on to investigate particular concerns among adolescents and ethnic minority groups. More recently we have used a longitudinal study to investigate the hypothesis that HPV vaccination might have a risk compensatory effect, encouraging girls to engage in risky sexual behaviour, and in a new project with colleagues at the Health Protection Agency and the London School of Hygiene and Tropical Medicine, we are collecting data on the characteristics of vaccinated and unvaccinated girls to model the likely impact of the vaccination programme on cervical cancer outcomes.

Our work has also involved 'laboratory' testing of HPV information, exploring the potentially stigmatising effects of associating cervical cancer with a sexually transmitted infection. We have also been using implicit methodology to explore emotional reactions to HPV information in relation to other standardised health information materials.

HPV testing is now being used to triage low-grade cervical abnormalities and reduce over-treatment of cervical lesions which would have regressed spontaneously. We have been investigating the psychological implications of testing positive for HPV and in collaboration with Dr Anne Szarewski (CR-UK) have also explored the acceptability of HPV self-testing in a number of groups.

With CR-UK funding, we have explored the reasons for the falling uptake in cervical cancer screening among young women (25-35 years) and cervical cancer screening among women who have immigrated to the UK from the European Union's newest states.

Key contacts: Dr Jo Waller, Dr Laura Marlow, Harriet Bowyer, Prof Jane Wardle

Collaborators: Dr Anne Szarewski, Prof John Edmunds, Dr Kirsten McCaffery, Prof Greg Zimet

Key publications:
Waller J, Jackowska M, Marlow L, Wardle J. (in press) Exploring age differences in reasons for non-attendance for cervical screening: a qualitative study. British Journal of Obstetrics and Gynaecology (in press). (view abstract)

Szarewski A, Cadman L, Mesher D, Austin J, Ashdown-Barr L, Edwards R, Lyons D, Walker J, Christison J, Frater A, Waller J. HPV self-sampling as an alternative strategy in non-attenders for cervical screening - a randomised controlled trial. British Journal of Cancer. 104, 2011, 915-20. (view abstract)

Marlow LAV. HPV vaccination among ethnic minorities in the UK: knowledge, acceptability and attitudes. British Journal of Cancer. 105, 2011, 486-92. (view abstract)

Forster AS, Marlow LAV, Wardle J, Stephenson J, Waller J. Understanding adolescents' intentions to have the HPV vaccine. Vaccine. 28, 2010, 1673-6. (view abstract)

Forster AS, Wardle J, Stephenson J, Waller J. Passport to promiscuity or life saver: press coverage of HPV vaccination and risky sexual behavior. Journal of Health Communication. 15, 2010, 205-17. (view abstract)

Marlow LAV, Waller J, Wardle J. The impact of HPV information on perceived risk of cervical cancer. Cancer Epidemiology Biomarkers and Prevention. 18, 2009, 373-6. (view abstract)

Marlow LAV, Wardle J, Forster A, Waller J. Ethnic differences in human papillomavirus awareness and vaccine acceptability. Journal of Epidemiology and Community Health. 63, 2009, 1010-1015. (view abstract)

Lloyd GP, Marlow LAV, Waller J, Miles A, Wardle J. An experimental investigation of the emotional and motivational impact of HPV information in adolescents. Journal of Adolescent Health. 45, 2009, 532-4. (view abstract)

Marlow LAV, Forster AS, Wardle J, Waller, J. Mothers' and adolescents' beliefs about risk compensation following HPV vaccination. Journal of Adolescent Health. 44, 2009, 446-51. (view abstract)

Marlow LAV, Waller J, Evans R, Wardle J. Predictors of interest in HPV vaccination: a study of British Adolescents. Vaccine. 27, 2009, 2483-2488. (view abstract)

Waller J, Bartoszek M, Marlow L, Wardle J. Barriers to cervical cancer screening attendance in England: a population-based survey. Journal of Medical Screening. 16, 2009, 199-204. (view abstract)

Waller J, Wardle J. HPV vaccination in the UK. British Medical Journal. 336: 1028-9. (view abstract)

Marlow LAV, Waller J, Wardle J. Socio-demographic predictors of HPV testing and vaccination acceptability: results from a population-representative sample of British women. Journal of Medical Screening. 15, 2008, 91-96. (view abstract)

Marlow L, Waller J, Wardle J. Public awareness that HPV is a risk factor for cervical cancer. British Journal of Cancer. 97, 2007, 691-4. (view abstract)

Marlow L, Waller J, Wardle J. Parental attitudes to pre-pubertal HPV vaccination. Vaccine. 25, 2007, 1945-1952. (view abstract)

Waller J, Marlow L, Wardle J. The association between knowledge of HPV and feelings of stigma, shame and anxiety. Sexually Transmitted Infectections. 83, 2007, 155-159. (view abstract)

'Analytic' and 'emotional' information processing: implications public understanding of cancer

Dr Katie Robb has been awarded a Cancer Research UK Post-doctoral Fellowship to investigate analytic and emotional information processing and their implications for public understanding of cancer. The goal is to discover how to design cancer education communications that engage the public and are therefore more effective.

Public understanding of the potential controllability of cancer through prevention and early detection remains low. Strategies are required to encourage public 'engagement' in the cancer control agenda, which includes discovering the most effective means of communicating about cancer detection and prevention. Evidence suggests that information is processed by two separate systems: the analytic/rational system and the emotional/experiential system. Cancer education communications predominantly target the analytic system which may disadvantage people who favour emotional over analytic processing.

We will be exploring the balance of analytic and emotional information processing in the context of bowel cancer screening.

Key contacts: Dr Katie Robb, Prof Jane Wardle

Collaborators: Prof Wendy Atkin, Dr Ellen Peters

Attitudes to cervical and breast cancer prevention/detection behaviours among ethnic minority women
Dr Laura Marlow was awarded a Cancer Research UK Post-doctoral Fellowship in 2010. Over three years this fellowship will investigate what barriers there are to early detection/prevention of cervical and breast cancer in ethnic minority women.

In the UK, there are fewer cases of cancer in people from ethnic minority groups than there are in the white population, but cancer is still a major cause of death among ethnic minorities and is expected to increase as a result of changing lifestyles. Worryingly, there is a lack of awareness about cancer signs and symptoms and reluctance to seek help from a doctor and engage in cancer screening among ethnic minorities. However, there has not been much research exploring why this is the case. This fellowship will use interviews and questionnaires to look at knowledge, understanding and attitudes to cancer and cancer detection/prevention among women aged 30-60 years. The findings will inform interventions designed to address barriers and reduce inequalities.

Key contacts: Dr Laura Marlow, Prof Jane Wardle

Collaborators: Prof James Nazroo

Cancer symptom appraisal in everyday life: psychological and demographic influences.
Dr Katriina Whitaker has been awarded a Cancer Research UK Post-doctoral Fellowship to investigate cancer symptom appraisal.

Failure to recognise symptoms as cancer has been identified as one of the key factors in patient delay. Existing research has investigated symptom appraisal either through retrospective reports from cancer patients or by asking the general population to estimate hypothetically how soon they would seek advice with a possible cancer symptom. However, both methods specifically identify the cancer context, whereas in everyday life, symptom evaluation occurs without any specific steer towards consideration of cancer, and consequently the decision-making process might be different. We will investigate psychological (e.g. fatalism) and demographic (e.g. sex) correlates of symptom appraisal in the context of everyday life.

Key contacts: Dr Katriina Whitaker, Prof Jane Wardle, Dr Alice Simon

Collaborators: Dr Suzanne Scott, Prof Una Macleod

This page last modified 24 Sept, 2011 by Mark Livermore

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