The big five and cervical screening barriers: Evidence for the influence of conscientiousness, extraversion and openness
Introduction
One of the most successful public health initiatives in the developed world has been the promotion of population-wide cervical cancer screening. A dramatic decrease in the incidence of cervical cancer followed the implementation of the Pap test, over 50 years ago (Kowalski & Brown, 1994). Despite the overwhelming success of screening initiatives, cervical cancer cases are still reported across Canada, largely due to the lack of screening (Health Canada, 2002). It remains the third most common cancer in women aged 20–49 (Fung-Kee-Fung, Animi, Howlett, & Innes, 2007) and worldwide, cervical cancer is the second leading cause of death among women (Schoell, Janicek, & Mirhashemi, 1999).
While the Pap test identifies cell changes on the cervix, a new testing method, HPV-DNA testing, has been developed to identify the presence of the human papillomavirus, the cancer-causing sexually-transmitted virus (Clifford, Smith, Munoz, & Franceschi, 2003) near the cervix. HPV-DNA self-sampling allows women to collect their own samples, and therefore has the potential to improve screening because it removes many of the barriers of the Pap test such as discomfort, pain, and embarrassment (Barata, Mai, Howlett, Gagliardi, & Stewart, 2008).
There is currently no consensus about which screening method is superior (Petignat et al., 2007), but in terms of the acceptance of self-sampling, women with a higher level of education and income have reported a preference for self-sampling over the Pap test (Dzuba et al., 2002, Stewart et al., 2007). A recent systematic review emphasized that the demographic variables associated with self-sampling acceptability are relatively well-known, but other characteristics of women who would be accepting of the screening method is an area of research that has yet to be fully explored (Stewart et al., 2007).
The big five personality theory – including neuroticism, extraversion, openness to experience, agreeableness and conscientiousness – offers an avenue of research to understand characteristics associated with cervical screening barriers. Among the five factors, conscientiousness, openness to experience and extraversion were of interest in particular due to the reported associations among the factors and relevant health perceptions and behaviors. Conscientiousness, a trait defined by characteristics such as competence, dutifulness, a strong work ethic, self-discipline and being well-organized (McCrae & Costa, 2003) has been linked to a variety of health behaviors including adherence to dialysis medical regimens (Christensen & Smith, 1995) and wellness behaviors including healthy eating and exercise (Bogg and Roberts, 2004, Booth-Kewley and Vickers, 1994). Additionally, conscientiousness is associated with physical and mental well-being (Goodwin & Friedman, 2006), and longitudinal research has indicated a strong link between conscientiousness and longevity (Friedman et al., 1995, Kern and Friedman, 2008, Martin et al., 2007). We note that, to the best of our knowledge, there have been no studies of conscientiousness and openness with respect to cervical screening, especially the novel self-sampling procedure.
Extraversion and openness have also been linked to health behaviors. Extraversion, a trait defined by characteristics such as being outgoing, sociable and experiencing positive emotions (McCrae & Costa, 2003) has also been positively correlated with adherence to gastric cancer screening among residents in Japan (Arai et al., 2009). Openness to experience, a personality factor defined by traits such as being imaginative, creative, curious, and having a preference for variety (McCrae & Costa, 2003) has been linked to the use of complementary and alternative medicine (Honda and Jacobson, 2005, Sirois and Gick, 2002).
The purpose of the present study was to investigate the influence of the big five personality factors on screening barriers. Perceived barriers, the psychosocial dimension of the Health Belief Model that has been described as the most important dimension in predicting health behaviors (Janz & Becker, 1984), was used as the dependent variable. Perceived barriers to the Pap test has received a great deal of attention in the literature (Glasgow et al., 2000, Hennig and Knowles, 1990, Hill et al., 1985, Kowalski and Brown, 1994, Price et al., 1996, Sutton and Rutherford, 2005), and more recently, barriers to self-sampling, such as not having confidence in doing the test properly and losing the benefit of a yearly appointment with a physician, have also been reported (Barata et al., 2008, Stewart et al., 2007).
Based on the characteristics associated with conscientiousness – self discipline, dutifulness and competence – and the previously noted past research linking conscientiousness with positive health behaviors (Bogg and Roberts, 2004, Booth-Kewley and Vickers, 1994, Christensen and Smith, 1995, Friedman et al., 1995, Kern and Friedman, 2008, Roberts et al., 2005), we hypothesized that conscientiousness would be inversely predictive of perceived Pap test barriers. The Pap test is the current standard in cervical screening and therefore individuals high on conscientiousness may feel they have a duty to obtain this type of screening and would be less likely to perceive barriers to it. However, conscientiousness might be inversely related to self-sampling because conscientious individuals might wish to be more cautious and wait for more evidence with this novel procedure.
We predicted that extraversion also would be associated with lowered barriers to both types of screening based on past research mentioned earlier that indicates a relationship between extraversion and gastric cancer screening (Arai et al., 2009). Finally, we hypothesized that openness to experience would be inversely predictive of perceived self-sampling barriers, a relatively novel medical procedure, due to its characteristics of curiosity and preference for variety (McCrae & Costa, 2003), and the aforementioned association between openness and use of complementary and alternative medicine (Honda and Jacobson, 2005, Sirois and Gick, 2002).
Section snippets
Participants
Two hundred and fifty-seven undergraduate female students were recruited in January and February 2009 through an online university participant pool. Participants ranged in age from 17 to 45 years (M = 20.31, SD = 3.82) and were given grade-raising credit (1%) in psychology courses for participation.
Big Five Inventory
The Big Five Inventory (BFI) is a 44-item scale that measures the big five personality factors using short phrases (John et al., 1991). In the present study, extraversion (α = 0.83), agreeableness (α = 0.71),
Descriptives
Among participants, 70% (n = 181) had sexual intercourse and 52% (n = 134) had obtained a Pap test. Descriptive statistics for the personality variables and screening barriers are presented in Table 2.
Correlations
Table 3 displays the zero-correlations between the personality factors, perceived Pap test barriers and perceived self-sampling barriers. Each of the personality factors correlated with Pap test barriers. All of the personality factors except for agreeableness also correlated with self-sampling
Discussion
Our results suggest that both personality and behavioral variables are important predictors of perceived cervical screening barriers. Conscientiousness, extraversion and openness were inversely predictive of perceived screening barriers; however, past behaviors were the most influential predictors across both the Pap test barriers model and the self-sampling barriers model.
Conclusion
The present study supports current theory and research that point to a link between personality and health and extends previous findings on health behaviors to barriers to preventive screening. Specifically, we found that personality factors of conscientiousness, extraversion and openness are important to consider in understanding lowered perceived barriers to the Pap test and the more novel cervical cancer screening method of self-sampling. Future research is needed to further understand the
Acknowledgments
This research was conducted as a part of the first author’s thesis for a Master of Arts degree, which was partially funded by a Joseph-Armand Bombardier Canada Graduate Scholarship (Social Sciences and Humanities Research Council).
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