Idiosyncratic ambivalence: A three-dimensional interpretative model to understand the non-adhesion of women to breast and cervical cancer screening

Daniela Lemmo, Maria Luisa Martino, Adele Nunziante Cesaro, Jan Helge Solbakk


Health programs offer screening activities for the early detection of cancer in vulnerable population, but record very low participation rates. The authors have a theoretical framework to investigate the complexity of the phenomenon, in the psychodynamic and ethical dimensions, specific to women. In this study, the authors used semi-structured interviews and interpretative phenomenological analysis to explore the meaning-making processes of women who do not practice breast and cervical cancer prevention in Southern Italy neither in the public health-care system, nor in private health facilities. Three superordinate themes have emerged: taking care of oneself would be to love oneself; difficult contact with a sexual body;at the end, the fate decides. We highlight three levels in the psychism that underlie the behavior of not doing prevention: body-> affects-> thought. Understanding these psychic level mechanisms permits to support women's health policy, reducing costs and promoting health.


Breast and cervical cancer screening; Women meaning-making; Interpretative phenomenological analysis; Health care; Risk prevention.

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Aasen, T., & Skolbekken, J.A. (2014) Preparing for and communicating uncertainty in cancer genetic counselling sessions in Norway: an interpretative phenomenological analysis, Health, Risk & Society, 16(4), 370-389. 10.1080/13698575.2014.927838

Abraham, K. (1924). Tentativo di una storia evolutiva della libido sulla base della psicoanalisi dei disturbi psichici. Opere. Vol.I. Torino: Bollati Boringhieri.

Ackerson, K., & Preston S.D. (2009). A decision theory perspective on why women do or do not decide to have cancer screening: systematic review. Journal Compilation, 65(6).

Adolfsson, A., Granevik, K., & Paulson, K. (2012). The Reasons Why Women Do Not Participate in the Pap Smear Screening and Testing Program in Sweden. Advances in Sexual Medicine, 2(3),31-37. 10.4236/asm.2012.23006

Al Dasoqui, K., Zeilani, R., Abdalrahim, M., & Evans, C. (2013). Screening for breast cancer among young Jordian women: ambiguity and apprehension. International Nursing Review, 60(3), 351–357.

Andersen, M. T., Smith, R., Meischke, H., Bowen, D. & Urban, N. (2003). Breast cancer worry and mammography use with and without a family history in a population based sample. Cancer epidemiology, biomarkers & prevention, 12, 314-320.

Arcidiacono, C. (1994). Identità femminile e psicoanalisi. Milano: Franco Angeli.

Bacqué, M.F. (2014). Psychothérapies analytiques en oncologie. Lavoisier.

Becker, M. H., & Maiman L.A. (1975). Social behavioral determinants of compliance with health and medical care recommendations. Medical Care, 13, 10-24.

Bekker, MHJ. (2003). Investigating gender within health research is more than sex disaggregation of data: A Multi-facet Gender and Health Model. Psychology, Health & Medicine 8(2), 231-243.

Bertini, M. (2012). Psicologia della salute., Milano: Raffaello Cortina.

Biondi, M., Costantini, A., & Parisi, A. (1996). Can loss and grief activate latent neoplasia? Psychotherapy and Psychosomatics, 65(2), 102-105.

Blomberg, K., Ternestedt, B.M., Tornberg, S., & Tishelman, C. (2008). How do women who choose not to participate in population-based cervical cancer screening reason about their decision? Psycho-Oncology, 17, 561–569.

Bollas, C. (1987). L’ombra dell’oggetto. Psicoanalisi del conosciuto non pensato, Roma, Borla, 1989.

Braibanti, P. (a cura di) (2008). Pensare la salute. Orizzonti e nodi critici della psicologia della salute. Milano: Franco Angeli.

Canales, M.K., & Geller, B.M. (2004) Moving in Between Mammography: Screening Decisions of American Indian Women in Vermont Qualitative Health Research, 14(6), 836-857.

Chasseguet-Smirgel, J. (2005). Il corpo come specchio del mondo. Milano: Cortina Raffaello.

Consedine, N.S., Magai C., Krivoshekova, Y.S., Ryzewicz, L., & Neugut A.I. (2004). Fear, Anxiety, Worry and Breast Cancer Screening Behaviour: A Critical Review. Cancer Epidemiol Biomakers Prevention, 13(4), 501-510.

De Luca Picione, R., Martino, M. L., & Troisi, G. (2019). The Semiotic Construction of the Sense of Agency. The Modal Articulation in Narrative Processes. Integrative Psychological and Behavioral Science, 53(3), 431–449.

De Masi, F. (2002). Il limite dell’esistenza. Un contributo psicoanalitico al problema della caducità della vita. Torino: Bollati Boringhieri.

Dejours, C. (2004) Il corpo, come esigenza di lavoro per il pensiero. In Debray R., Dejours C. & Fèdida, P. Psicopatologia dell’esperienza del corpo. Roma: Borla.

Dicé F., Dolce P., Maiello A. & Freda M.F. (2020). Exploring emotions in dialog between health provider, parent and child. An observational study in pediatric primary care. Pratiques Psychologiques, 26, 69-84. 10.1016/j.prps.2018.12.001.

Duberstein, P.R., & Masling J.M. (a cura di) (2000) Psychodynamic Perspectives on Sickness and Health. Amer Psychological Assn.

Facchin, F., & Saita, E., (2017). L’impatto psicologico del Papillomavirus: quando la fiducia si ammala, in Acquati, C., & Emanuela Saita, E., Affrontare insieme la malattia. Il coping diadico fra teoria e pratica, Carocci, Roma 2017: 87-106

Fantinelli, S., Marchetti, D., Verrocchio, M. C., Franzago, M., Fulcheri, M., Vitacolonna, E. (2009). Assessment of Psychological Dimensions in Telemedicine Care for Gestational Diabetes Mellitus: A Systematic Review of Qualitative and Quantitative Studies. Frontiers in Psychology, 10(153), 1-15.

Ferenczi, S. (1929) Il bambino mal accolto e la sua pulsione di morte. in Opere vol IV Milano: Cortina, 2002

Ferraro, F., & Nunziante Cesàro, A. (1985). Lo spazio cavo e il corpo saturato. Milano: Franco Angeli.

Fowler, B.A. (2006). Claiming health: mammography screening decision making of African American women. Oncology Nursing Forum, 33(5), 969–982

Freda, M.F., Gonzàlez-Monteagudo, J., Esposito, G. (2016) (Eds). Working with Underachieving Students in Higher Education: Fostering Inclusion through Narration and Reflexivity. Abingdon: Oxon; New York: NY; Routledge. 10.4324/9781315659121

Freud, S., (1920). Al di là del principio di piacere. In O.S.F., Vol.9. Torino: Bollati Boringhieri, 1977.

Galdon, M.J., Andreu Y., & Dura E. (1997). Determinantes psicosociales de la practica de autoexploracion mamaria. Boletin de Psicologia, 57, 77-96.

Garotti, P.L., Candini, L., Ricci Bitti, P.E., & Scioli, A. (2003). Studio sulle credenze e gli atteggiamenti personali in tema di prevenzione dei tumori del collo dell’utero e della mammella. Psicologia della Salute, 3, 41-59.

Gurevich, M., Devins, G. M., and Rodin, G. M. (2002). Stress response syndromes and cancer: conceptual and assessment issues. Psychosomatics 43, 259–281. 10.1176/appi.psy.43.4.259

Harcourt, N., Ghebre, R.G., Whembolua, G., Zhang, Y., Osman, S.W., & Okuyemi K.S. (2014). Factors Associated with Breast and Cervical Cancer Screening Behavior Among African Immigrant Women in Minnesota. J Immigrant Minority Health, 16(3), 450-456. 10.1007/s10903-012-9766-4

Head, K.J.; & Cohen, E. L. (2011). Young Women’s Perspectives on Cervical Cancer Prevention in Appalachian Kentucky. Qualitative Health Research, 22(4), 476-487.

Langer, E.J., & Rodin, J. (1976). The effects of choice and enhanced personal responsibility for the aged. Journal of Personality and Social Psychology, 34(2), 191-198.

Lenzo, V., Sardella, A., Martino, G., & Quattropani, M. C. (2020). A Systematic Review of Metacognitive Beliefs in Chronic Medical Conditions. Frontiers in psychology, 10, 2875. 10.3389/fpsyg.2019.02875

Levinas, E. (1991). Entre nous. Essais sur le penser à l’autre. Paris: Grasset.

Manjer, A.R., Zackrisson, S., & Emilsson, U.M. (2014). On women’s ambivalence about mammography screening: support in the decision-making process a potential role for health care social workers? British Journal of Social work, 46(2), 480-497.

Marlow, L., Waller, J., & Wardle, J. (2015). Barriers to cervical cancer screening among ethnic minority women: a qualitative study. Fam Plann Reprod Health Care, 0, 1–7.

Martino, G., Catalano, A., Bellone, F., Langher, V., Lasco, C.G., Penna, C., Nicocia, G., Morabito, N. (2020). Quality of life in postmenopausal women: which role for vitamin D? Mediterranean Journal of Clinical Psychology, 6(2).

Martino, G., Langher, V., Cazzato, V., and Vicario, C.M. (2019a). Editorial: Psychological Factors as Determinants of Medical Conditions. Front. Psychol, 10, 2502.

Martino, M. L., & Freda, M. F. (2016). Meaning-Making Process Related to Temporality During Breast Cancer Traumatic Experience: The Clinical Use of Narrative to Promote a New Continuity of Life. Europe’s Journal of Psychology, 12(4), 622–634. 10.5964/ejop.v12i4.1150

Martino, M. L., De Luca Picione, R., Lemmo, D., Boursier, V., & Freda, M. F. (2019b). Meaning-Making Trajectories of Resilience in Narratives of Adolescents with Multiple Sclerosis. Mediterranean Journal of Clinical Psychology, 7(2), 1-25. 10.6092/2282-1619/2019.7.2049

Martino, M. L., Gargiulo, A., Lemmo, D., Dolce, P., Barberio, D., Abate, V., Avino, F., & Tortriello, R. (2019c). Longitudinal effect of emotional processing on psychological symptoms in women under 50 with breast cancer. Health Psychology Open, 6(1), 1-9.

Martino, M.L., Lemmo, D., Gargiulo, A., Barberio, D., Abate, V., Avino, F., &Tortoriello, R. (2019d). Underfifty Women and Breast Cancer: Narrative Markers of Meaning-Making in Traumatic Experience. Frontiers in Psychology, 10, 618, 1-12. 10.3389/fpsyg.2019.00618

McBride, E., Tatar, O., Rosberger, Z., Rockliffe, L., Marlow, L. M., Moss-Morris, R., Kaur, N., Wade, K., & Waller, J. (2020). Emotional response to testing positive for human papillomavirus at cervical cancer screening: a mixed method systematic review with meta-analysis. Health psychology review, 1–35. Advance online publication. 10.1080/17437199.2020.1762106.

Mehnert, A., and Koch, U. (2007). Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: a prospective study. Psychooncology 16, 181–188. 10.1002/pon.1057

Menninger, K. A. (1938). Man Against Himself. Harvest Books: Harcourt.

Newberry, A.M. (2011). Book Review: Interpretative Phenomenological Analysis: Theory, Method and Research. Qualitative Health Research, 21(9), 1298-1300.

Norfjord Van Zyl, M., Akhavan, S., Tillgren, P., & Asp, M., (2018). Experiences and perceptions about undergoing mammographic screening: a qualitative study involving women from a county in Sweden. International Journal of Qualitative Studies on Health and Well-being, 13(1), 152-256. 10.1080/17482631.2018.1521256

Nunziante Cesàro, A. (2014). Chiaroscuri dell’identità. Sessuazione, sesso e genere. Una lettura psicoanalitica. Milano: Franco Angeli.

Oscarsson, M.G., Wijma, B.E., & Benzein, E.G. (2008). 'I do not need to... I do not want to... I do not give it priority...'.why women choose not to attend cervical cancer screening. Health Expect, 11(1), 26-34.

Paganucci, C., Primi C., & Siani R. (2002). Locus of control sulla salute e screening mammografico. Psicologia della Salute, 2, 75-90.

Parat, H. (2000). L’erotico materno, Psicoanalisi dell’allattamento. Roma: Borla.

Payne, D.K., Hoffman, R.G., Theodoulou, M., Dosik, M., & Massie M.J. (1999). Screening for anxiety and depression in women with breast cancer. Psychosomatics, 40(1), 64-69.

Pietkiewicz, I., & Smith, J. (2014). A practical guide to using Interpretative Phenomenological Analysis in qualitative research psychology. Psychological Journal, 20(1) 7-14. 10.14691/CPPJ.20.1.7

Plourde, N., Brown, H.K., Vigod, S., & Cobigo, V. (2016). Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature, Women & Health, 56(8), 906-925.

Quattropani, M.C., Lenzo, V., & Filastro, A. (2018). The role of metacognitions in multiple sclerosis: a clinical study and assessment of possible correlation with anxiety, depression and coping strategies. Euromediterranean Biomedical Journal, 13(9), 39-45. 10.3269/1970-5492.2018.13.9

Rahnea-Nita,R., Paunica, S., Motofei, C., Rahnea-Nita, G. (2019). Assessment of anxiety and depression in patients with advanced gynaecological cancer. Mediterranenan Journal of Clinical Psychology, 7(2), 11.

Reich, M. (2009). Cancer et image du corps: identité, représentation et symbolique. L’Information Psychiatrique, 85(3), 247-254.

Ricci Bitti, P.E., Candini, L., Garotti P.L., & Scioli A. (2000). Fattori predittivi del comportamento preventivo in tema di tumori della mammella del collo dell’utero. In Reda, M.A. & Benevento, D. (a cura di) Significato e senso della malattia. Siena: Tipografia senese.

Rimal, R.N., & Real, K. (2003). Perceived risk and efficacy beliefs as motivators of change. Use of the risk perception attitude (RPA) framework to understand health behaviors. Human Communication Research 29(3), 370–399.

Rippetoe, P.A., & Roger S.R.W. (1987). Effects of components of protection- motivation theory on adaptive and maladaptive coping with a health threat. J Pers Soc Psychology, 52(3), 596-604.

Rollero, C. (2014). Salute in una prospettiva di genere. In De Piccoli N. (a cura di) Salute e qualità della vita nella società del benessere. Roma: Carocci.

Rummans, T.A., Frost, M., Suman, V.J., Taylor, M., Novotny, P., Gendron, T., Johnson, R., Hartman, L., Dose, A.M., & Evans R.W. (1998). Quality of life and pain in patients with recurrent breast and gynecologic cancer. Psychosomatics, 39(5), 437-445.

Scheier, M.F., & Carver, C.S. (1987). Dispositional optimism and physical wellbeing. Journal of Personality, 55, 169-210.

Schoenberg, N.E., Studts, C.R., Hatcher-Keller, J., Buelt E., & Adams. E. (2013). Patterns and Determinants of Breast and Cervical Cancer Non-Screening Among Appalachian Women.Women & Health, 53(6), 552-571.

Silverman, E., Woloshin, S., Schwartz L.M., Byram, S.J., Welch, H.G., & Fischhoff, B., (2001). Women’s Views on Breast Cancer Risk and Screening Mammography. A qualitative interview study. Medical Decision Making, 21, 231-240.

Smith, J., (1996). Beyond the divide between cognition and discourse: Using interpretative phenomenological analysis in health psychology. Psychology & Health, 11, 261-271.

Smith, J., (2007). Hermeneutics, human sciences and health: linking theory and practice. International Journal of Qualitative Studies on Health and Well Being, 2, 3-11.

Smith, J.A., & Osborn, M. (2003). Interpretative phenomenological analysis. In J.A. Smith (Ed.), Qualitative Psychology: A Practical Guide to Methods. London: Sage.

Smith, J.A., Flowers, P., & Larkin, M. (2009). Interpretative Phenomenological Analysis. Theory, Method and Research. London: Sage.

Solbakk, J. H., Bentzen, H. B., Holm, S., Heggestad, A.K.T., Hofmann, B.M., Robertsen, A. Alnæs, Anne Hambro; Cox, Shereen; Pedersen, Reidar & Bernabe, Rosemarie de la Cruz (2020). Back to WHAT? The role of research ethics in pandemic times. Medicine, Health care and Philosophy. 10.1007/s11019-020-09984-x

Solbakk, J.H. (2019) Bioethics & Human Development. Taylor & Francis

Solbakk, J.H. (2015). What is it to do good medical ethics? On the concepts of 'good' and 'goodness' in medical ethics. Journal of Medical Ethics, 41(1), 12-16.

Sontag, S. (2002). Malattia come metafora. Cancro e Aids. Milano: Mondadori.

Teng, F.F., Mitchell, S.M., Sekikubo, M., Biryabarema, C., Byamugisha, J.K., Steinberg, M., Money, D.B., & Ogilvie, G.S. (2014). Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda. BMJ Open,1-9.

Tessaro, I., Eng, E., & Smith J. (1994). Breast cancer screening in older African- American women: qualitative research findings. American Journal of Health Promotion 8(4), 286–292.

Tessitore, F., Glovi, F. A., Margherita, G. (2019). Pre- and post-migratory experiences of refugees in Italy: an interpretative phenomenological analysis. Mediterranean Journal of Clinical Psychology, 7(3), 1-18.

Vernet, A., & Henry F. (2007). Prévention du cancer du sein et facteurs psychosociaux. Le Journal des psychologies, 247, 54-57. 132

Villani, D., Cognetta, C., Toniolo, D., Scanzi, F., and Riva, G. (2016). Engaging elderly breast cancer patients: the potential of eHealth interventions. Front. Psychol. 7:1825. doi: 10.3389/fpsyg.2016. 01825

Waller J, Jackowska M, Marlow L, & Wardle J. (2012). Exploring age differences in reasons for nonattendance for cervical screening: a qualitative study. BJOG,119, 26–32.

Zani, B., & Cicognani, E. (2000). Psicologia della salute. Bologna: Mulino.

Zani, B., & Pietrantoni, L. (2000). Donne e salute: un modello per predire l’intenzione ad eseguire il Pap-test. Psicologia della Salute, 1, 51-66.



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