S Forrest

University College London, London, ENG, United Kingdom

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Publications (7)51.79 Total impact

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    ABSTRACT: The study measured the acceptability of self-sampling for human papillomavirus (HPV) testing in the context of cervical cancer screening. Women carried out self-sampling unsupervised, using a written instruction sheet. Participants were women attending either a family planning clinic or a primary care trust for routine cervical screening. Women (n = 902) carried out self-sampling for HPV testing and then a clinician did a routine cervical smear and HPV test. Immediately after having the two tests, participants completed a measure of acceptability for both tests, and answered questions about ease of using the instruction sheet and willingness to use self-sampling in the future. The majority of women found self-sampling more acceptable than the clinician-administered test, but there was a lack of confidence that the test had been done correctly. Significant demographic differences in attitudes were found, with married women having more favourable attitudes towards self-sampling than single women, and Asian women having more negative attitudes than women in other ethnic groups. Intention to use self-sampling in the future was very high across all demographic groups. Self-sampling for HPV testing was highly acceptable in this large and demographically diverse sample, and women were able to carry out the test alone, using simple written instructions. Consistent with previous studies, women were concerned about doing the test properly and this issue will need to be addressed if self-sampling is introduced. More work is needed to see whether the demographic differences we found are robust and to identify reasons for lower acceptability among single women and those from Asian background.
    Journal of Medical Screening 02/2006; 13(4):208-13. · 2.72 Impact Factor
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    ABSTRACT: To examine the psychosocial impact of testing positive for high risk human papillomavirus (HPV) among women attending primary cervical screening. Cross sectional survey. Measures were taken at baseline and one week after the receipt of HPV and cytology screening results. Well women's clinic in London, UK. Population or Sample Four hundred and twenty-eight women aged 20-64 years. Postal questionnaire survey. Psychosocial and psychosexual outcomes were anxiety, distress and feelings about current, past and future sexual relationships. Women with normal cytology who tested positive for HPV (HPV+) were significantly more anxious and distressed than women who were negative (HPV-) using both a state anxiety measure [F(1,267) = 29, P < 0.0001] and a screening specific measure of psychological distress [F(1,267) = 69, P < 0.0001]. Women with an abnormal or unsatisfactory smear result, who tested HPV+, were significantly more distressed than HPV- women with the same smear result [F(1,267) = 8.8, P = 0.002], but there was no significant difference in state anxiety. Irrespective of cytology result, HPV+ women reported feeling significantly worse about their sexual relationships. Approximately one-third of women who tested positive reported feeling worse about past and future sexual relationships compared with less than 2% of HPV- women. The findings suggest that testing positive for HPV may have an adverse psychosocial impact, with increased anxiety, distress and concern about sexual relationships. Psychosocial outcomes of HPV testing need further investigation and must be considered alongside clinical and economic decisions to include HPV testing in routine cervical screening.
    BJOG An International Journal of Obstetrics & Gynaecology 01/2005; 111(12):1437-43. · 3.86 Impact Factor
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    ABSTRACT: There is now overwhelming evidence that high-risk, sexually transmitted types of human papillomavirus (HPV) are the main causal agent in cervical cancer. Biobehavioral and psychosocial research is uniquely capable of addressing many of the issues raised by HPV and its link with cervical cancer. In this article we review current findings in this area and identify issues for future research. The first of the three sections explores issues associated with the introduction of HPV testing for the detection and management of cervical abnormalities and the impact of growing public awareness of the sexually transmitted nature of cervical cancer. The implications for public understanding of cervical cancer, psychosocial issues associated with screening, and the potential impact on screening uptake are discussed. The second section addresses the role of biobehavioral factors in the persistence and progression of HPV infection as well as possible interventions to minimize the risk of persistence. Finally, primary prevention of HPV is discussed.
    Annals of Behavioral Medicine 03/2004; 27(1):68-79. · 4.20 Impact Factor
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    ABSTRACT: To examine attitudes to self-sampling for human papillomavirus (HPV) testing among women from contrasting ethnic groups. Manchester, UK. Two hundred women of Indian, Pakistani, African-Caribbean and white British origin were recruited from social and community groups to participate in a questionnaire survey. The questionnaire included items on attitudes to self-sampling and intention to use the test. Willingness to try to use the test was high, and women did not foresee religious or cultural barriers to self-sampling; however, a large proportion of women were concerned about doing the test properly. This concern was greatest in the Indian and African-Caribbean groups. Although women's willingness to try self-sampling for HPV is encouraging, worries about carrying out the procedure correctly must be addressed if women are to feel confident about the results of self-sampling methods and reassured by a negative result.
    Journal of Medical Screening 02/2004; 11(2):85-8. · 2.72 Impact Factor
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    ABSTRACT: To assess the level and accuracy of public understanding of human papillomavirus (HPV) in the United Kingdom. Women attending a well woman clinic were asked to complete a questionnaire assessing HPV awareness and specific knowledge about the virus. Questionnaires were completed by 1032 women, of whom 30% had heard of HPV. Older women, non-smokers, and those with a history of candida, genital warts, or an abnormal smear result were more likely to have heard of HPV. Even among those who had heard of HPV, knowledge was generally poor, and fewer than half were aware of the link with cervical cancer. There was also confusion about whether condoms or oral contraceptives could protect against HPV infection. In this relatively well educated sample, awareness and knowledge of HPV were poor. Public education is urgently needed so that women participating in cervical cancer screening are fully informed about the meaning of their results, especially if HPV testing is soon to be introduced.
    Sexually Transmitted Infections 09/2003; 79(4):320-2. · 3.08 Impact Factor
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    ABSTRACT: This study examined attitudes to human papillomavirus (HPV) testing among a purposively selected sample of women from four ethnic groups: white British, African Caribbean, Pakistani and Indian. The design was qualitative, using focus group discussion to elicit women's attitudes towards HPV testing in the context of cervical cancer prevention. The findings indicate that although some women welcomed the possible introduction of HPV testing, they were not fully aware of the sexually transmitted nature of cervical cancer and expressed anxiety, confusion and stigma about HPV as a sexually transmitted infection. The term 'wart virus', often used by medical professionals to describe high-risk HPV to women, appeared to exacerbate stigma and confusion. Testing positive for HPV raised concerns about women's sexual relationships in terms of trust, fidelity, blame and protection, particularly for women in long-term monogamous relationships. Participation in HPV testing also had the potential to communicate messages of distrust, infidelity and promiscuity to women's partners, family and community. Concern about the current lack of available information about HPV was clearly expressed and public education about HPV was seen as necessary for the whole community, not only women. The management of HPV within cervical screening raises important questions about informed participation. Our findings suggest that HPV testing has the potential to cause psychosocial harm to women and their partners and families.
    British Journal of Cancer 02/2003; 88(1):42-6. · 4.82 Impact Factor
  • JAMA The Journal of the American Medical Association 10/2002; 288(11):1350; author reply 1351-2. · 30.39 Impact Factor

Publication Stats

347 Citations
51.79 Total Impact Points


  • 2003–2006
    • University College London
      • Department of Epidemiology and Public Health
      London, ENG, United Kingdom
  • 2005
    • University of Sydney
      • School of Public Health
      Sydney, New South Wales, Australia