The perception gap: how the benefits and harms of cervical cancer screening are understood in information material focusing on informed choice

The benefits and harms of cervical cancer screening are delicately balanced, and in that sense, many argue that participation should be based on an informed choice. Information pamphlets play a central part in the process of obtaining informed consent from women, and therefore adequate communication about health and risk is essential. However, pamphlets on screening have been shown to be information poor and biased in favour of participation, and little attention has been paid to how the pamphlets are understood. The aim of this study was twofold: 1) to develop evidence-based information material on cervical cancer screening; and 2) to investigate how women understand and interpret this information. We carried out semi-structured interviews with 17 women aged 23-55 in two interview rounds. We analysed the transcribed interviews using meaning condensation theory, which we followed with a second order analysis guided by approaches to cognitive dissonance. Generally, we found that the newly developed information succeeded in presenting understandable health and risk information on cervical cancer screening. Participants, however, still sometimes struggled with understanding the numerical risk and their preconceptions about screening led them to focus on the benefits and downplay the harms. According to cognitive dissonance theory, our second finding points to the use of defence mechanisms which create aperception gapbetween the written information and the participants' understanding of the information. We conclude by arguing that breaching the perception gap is necessary if we want to increase possibilities for making an informed choice about participation in cervical cancer screening.