Objectives: A systematic review was performed to examine the effects of cholesterol, breast cancer, and cervical cancer screening on actual or intended health-promoting behaviors and health-related beliefs.
Methods: Eleven electronic databases (between 1980 and 2000) served as data sources. All English language studies that investigated the impact of cholesterol, breast, and cervical screening programs on health-promoting behaviors and beliefs were assessed for inclusion. The data extraction form and quality assessment criteria were developed using the National Health Service Centre for Reviews and Dissemination guidelines. Data were extracted, and a nonquantitative synthesis was conducted. Reviewers categorized the outcomes into those that could be considered beneficial or detrimental to health. This categorization was based on a value judgment that considered both statistical and clinical significance.
Results: The cholesterol studies used prospective designs more frequently, possibly as many investigators focused on observing changes in lifestyle after screening. Participants who went for breast or cervical screening were not offered advice on lifestyle changes, and most of the research into cancer screening programs investigated issues related to uptake of screening services, explanations of why people are or are not screened, and interventions to improve uptake. All three screening programs are associated with high levels of favorable health behaviors and beliefs that have been measured, although there is evidence that recommended follow-up after screening is often not adhered to. There was no literature on the cost-effectiveness regarding the wider implications of screening (only on reduction of disease-specific mortality/morbidity), possibly due to the outcomes being very broad and not easily categorized and classified.
Conclusions: The studies reviewed suggest that cholesterol screening had a positive effect on health behaviors, although participation was voluntary and those screened were possibly more motivated to make changes. These results, therefore, are not generalizable to the entire population, and other factors need to be taken into account. Reduction in blood cholesterol levels was reported in all but two of the studies that assessed this outcome, suggesting that successful lifestyle changes were made. However, as most of the studies only reported follow-up of those screened, some of the reduction can be attributable to regression to the mean. Whether breast and cervical screening affect future health behaviors and beliefs has not been directly measured in many studies, and few studies have collected baseline measures. However, evidence suggests that women who attend breast and cervical screening once are likely to reattend, and attendance is associated with several positive health behaviors, although it cannot be confirmed whether the associations observed were a result of screening or because these women have a certain set of health behaviors and beliefs irrespective of their experience of screening. Areas of further research include measuring a much wider range of behaviors and beliefs before and after screening is accepted or declined, examining the subgroup of participants who receive “desirable” results and the impact of this on health beliefs and health-promoting behavior, and qualitative research into the experiences of screening and how this finding interacts with knowledge and beliefs about other aspects of health.
