EXPLICIT ATTITUDES SEEM MORE DECISIVE FOR INTENTIONS ABOUT CERVICAL CANCER SCREENING THAN IMPLICIT ATTITUDES

Purpose: The impact of implicit (associative) attitudes on preventive behaviors, such as screening for cancer, is largely unknown. We measured the relation of implicit versus explicit attitudes with intentions regarding cervical cancer screening. Additionally, we assessed the impact of an information leaflet on these attitudes.

Method: In a randomized design, 74 female students of Leiden University, the Netherlands, completed assessments at baseline and 2 weeks follow-up. Implicit attitudes were measured with an affective priming task (Fazio, 1986) containing a screening prime (“Pap smear”), a neutral prime, and a non-word. Each prime was followed by a positive or negative target word and participants had to indicate the target’s valence. Response times to these targets were measures for implicit attitudes. Additionally, we developed a belief-based attitudes scale to assess explicit attitudes, addressing relevance (range 1-7) and evaluation (range -3 to +3) of 6 characteristics of cervical screening. Moreover, an item was included to assess intentions regarding cervical screening (7-point scale: ‘Definitely no’ – ‘Definitely yes’). At baseline, participants were given a short explanation of the cervical cancer screening program. At follow-up the intervention arm was asked to first read the leaflet of the Dutch national cervical cancer screening program, the control arm did not receive additional materials.

Result: In both conditions and at both assessments, longer response times were seen for the screening prime combined with negative targets, indicating difficulties to link “Pap smear” to negative words. The priming task showed similar reaction times for all other combinations of primes and targets. At baseline, intentions of the intervention group considering cervical screening were correlated with both implicit (i.e., screening prime with negative targets; R=0.38; p=0.024) and explicit attitudes (R=0.60; p<0.001). After having read the screening leaflet, correlations with implicit attitudes decreased (R=0.14; p=0.42), while correlations with explicit attitudes remained unchanged (R=0.58; p<0.001). Slightly fewer women intended to be screened (p=0.13).

Conclusion: Following a brief description of the cervical cancer screening program, participants indicated their preferences for screening for the first time. Screening intentions were more strongly related to explicit than to implicit preferences in both groups. Reading a leaflet about the cervical screening program slightly enforced this pattern.