Authors' objectives:

To carry out a systematic review to examine the effects of cholesterol, breast and cervical cancer screening on actual or intended health-promoting behaviours and health-related beliefs.

In particular, the review addressed the following questions:

- What are the effects of screening for hypercholesterolaemia, breast cancer and cervical cancer on future health beliefs and behaviours? - What are the implications for the NHS?

Authors' results and conclusions: The study designs used in the three screening types differed. The cholesterol studies used prospective designs more frequently. This may be explained by differing research agendas as the majority of the cholesterol papers were interested in observing changes in lifestyle following screening. However, participants who went for breast or cervical screening were not offered advice on lifestyle changes and most of the research into cancer screening programmes investigated issues related to uptake of screening services, explanations of why people are or are not screened and interventions to improve uptake. All three screening programmes are associated with high levels of favourable health behaviours and beliefs that have been measured, although there is evidence that recommended follow-up after screening is often not adhered to. However, most of the research has been restricted to outcomes related to the condition being screened for (e.g. cancer-related beliefs as related to cancer screening). To explore fully the effects of screening on future health behaviours and beliefs a much wider range of outcomes should be studied. There were very few qualitative studies that could have provided a better understanding of how and why participants in screening are affected by the processes they have undergone. There was no literature on the cost-effectiveness regarding the wider implications of screening (only on reduction of disease-specific mortality/morbidity). This is possibly due to the outcomes being very broad and not easily categorised and classified.

Authors' recommendations: Cholesterol screening: The studies reviewed suggest that cholesterol screening had a positive effect on health behaviours. However, these positive findings need to be interpreted in the light of methodological issues. For example, participation was voluntary and those screened were possibly more motivated to make changes. These results are therefore not generalisable to the entire population. Other factors include the lack of reliability and validity of tools to measure changes in health behaviours, study attrition and uncertainty of self-reports. Furthermore, uncertainty of long-term changes, inaccurate risk assessment, perception of cholesterol testing in a non-medical environment, perception of seriousness of the risk status due to lack of symptoms, readiness to accept advice, and convenience and cost of follow-up should all be considered. Reduction in blood cholesterol levels was reported in all but two of the studies that assessed this outcome, suggesting that successful lifestyle changes were made. However, as most of the studies only reported follow-up of those screened, some of the reduction can be attributable to regression to the mean. Breast and cervical screening: Whether breast and cervical screening affect future health behaviours and beliefs has not been directly measured in many studies and few studies have collected baseline measures. Therefore, it is difficult to answer with certainty the question of what are the effects of these screening programmes on future health beliefs and behaviours. However, evidence suggests that women who attend breast and cervical screening once are likely to reattend and attendance is associated with several positive health behaviours. Many of these studies were cross-sectional or relied on retrospective data collection where the temporal relationship between screening and these behaviours cannot be assessed. Therefore, it cannot be confirmed whether the associations observed were a result of screening or because these women have a certain set of health behaviours and beliefs irrespective of their experience of screening.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1179

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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