Section of General Practice and Research Unit for General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, P. O. Box 2099, DK-1014, Copenhagen, Denmark.
Primary Health Care Research Unit, Region Zealand, Denmark.
BMC Psychol. 2018 Aug 10;6(1):39. doi: 10.1186/s40359-018-0251-2.
Cervical cancer screening will inevitably lead to unintentional harmful effects e.g. detection of indolent pathological conditions defined as overdetection or overdiagnosis. Overdiagnosis often leads to overutilisation, overtreatment, labelling and thereby negative psychosocial consequences. There is a lack of adequate psychosocial measures when it comes to measurement of the harms of medical screening. However, the Consequences of Screening questionnaire (COS) has been found relevant and comprehensive with adequate psychometric properties in breast and lung cancer screening. Therefore, the aim of the present study was to extend the Consequences of Screening Questionnaire for use in cervical cancer screening by testing for content coverage, dimensionality, and reliability.
In interviews, the suitability, content coverage, and relevance of the COS were tested on participants in cervical screening. The results were thematically analysed to identify the key consequences of abnormal screening results. Item Response Theory and Classical Test Theory were used to analyse data. Dimensionality, invariance, and reliability were established by item analysis, examining the fit between item responses and Rasch models.
All COS items were found relevant by the interviewees and the ten COS constructs were confirmed each to be unidimensional in the Rasch models. Ten new themes specifically relevant for participants having abnormal cervical screening result were extracted from the interviews: 'Uncertainty about the screening result', 'Uncertainty about future pregnancy', 'Change in body perception', 'Change in perception of own age', 'Guilt', 'Fear and powerlessness', 'Negative experiences from the pelvic examination', 'Negative experiences from the examination', 'Emotional reactions' and 'Sexuality' Altogether, 50 new items were generated: 10 were single items. Most of the remaining 40 items were confirmed to fit Rasch models measuring ten different constructs. However, the two items in the scale 'Change in perception of own age' both possessed differential item functioning in relation to time, which can bias longitudinal repeated measurement.
The reliability and the dimensionality of a condition-specific measure with high content validity for women having an abnormal cervical cancer screening results have been demonstrated. This new questionnaire called Consequences Of Screening in Cervical Cancer (COS-CC) covers in two parts the psychosocial experience in cervical cancer screening.
宫颈癌筛查不可避免地会导致无意的有害影响，例如检测到惰性病理状况，定义为过度检测或过度诊断。过度诊断通常会导致过度使用、过度治疗、标记，从而带来负面的心理社会后果。在衡量医学筛查的危害时，缺乏足够的心理社会措施。然而，《筛查后果问卷》（COS）已被证明在乳腺癌和肺癌筛查中具有相关性和全面性，且具有足够的心理测量学特性。因此，本研究的目的是通过测试内容涵盖范围、维度和可靠性，将《筛查后果问卷》扩展到宫颈癌筛查中。
在访谈中，对参加宫颈癌筛查的参与者测试了 COS 的适用性、内容涵盖范围和相关性。通过主题分析确定异常筛查结果的关键后果。使用项目反应理论和经典测试理论分析数据。通过项目分析，检查项目反应与 Rasch 模型之间的拟合程度，来确定维度、不变性和可靠性。
所有的 COS 项目都被受访者认为是相关的，在 Rasch 模型中，10 个 COS 结构被证实每个都是单维的。从访谈中提取了 10 个新的主题，这些主题特别与异常宫颈筛查结果的参与者有关：“对筛查结果的不确定性”、“对未来怀孕的不确定性”、“对身体感知的改变”、“对自身年龄感知的改变”、“内疚感”、“恐惧和无力感”、“盆腔检查的负面经历”、“检查的负面经历”、“情绪反应”和“性行为”。总共生成了 50 个新的项目：10 个是单项项目。其余 40 个项目中的大多数都被证实符合测量 10 个不同结构的 Rasch 模型。然而，“对自身年龄感知的改变”量表中的两个项目在时间上都存在差异项目功能，这可能会使纵向重复测量产生偏差。
已经证明了一种具有高内容有效性的针对异常宫颈癌筛查结果女性的特定条件的测量工具具有可靠性和维度性。这种新的问卷称为《宫颈癌筛查后果问卷》（COS-CC），分为两部分，涵盖了宫颈癌筛查中的心理社会体验。
