Understanding the uptake of cervical cancer screening: the contribution of the health belief model.

The health belief model, explaining health and illness behaviour, is 25 years old. Criticisms of the model have included its abstract nature and its emphasis on the rationality of patients' behaviour. Its lack of predictive power means it provides a useful framework rather than a true model. The health belief model is used here to review the literature that has advanced our understanding of the factors affecting uptake of cervical screening. The influence of age and social class on perceptions of vulnerability, and the costs and benefits of screening are highlighted. The body of work reviewed has helped expose inherent limitations of screening programmes. The main obstacles to the success of cervical screening are organizational, for example, the inaccuracy of address registers. Numerous ways of encouraging uptake are identified. These include appropriately worded invitations and educational material, personalized approaches from members of the primary health care team and flexible surgery hours. The incentives introduced under the 1990 general practitioner contract are likely to help increase uptake.