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    Choice, morality and vulnerability : young women's discourses of cervical screening : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology (endorsement in Health Psychology) at Massey University, Albany, New Zealand
    (Massey University, 2016) Coulter, Holly
    Cervical screening is a health surveillance tool used to prevent cervical cancer. In New Zealand, research into cervical screening has largely focused on barriers to participation. This type of research implicitly assumes that cervical screening is a desirable health behaviour for women to engage in, and does not explore how social and political factors are implicated in cervical screening behaviour. This research sought to explore women’s understandings and experiences of cervical screening. Ten women aged 20 to 30 were interviewed, their responses recorded and transcribed, and an interpretive analysis conducted. From the analysis, three broad webs of discourse surrounding cervical screening – choice, morality and vulnerability – were identified and discussed. Each web of discourse was used to construct cervical screening in different ways. For choice, participants constructed cervical screening as an autonomous choice, routine, or an obligation. Morality was drawn upon for its role in cervical screening around ideas of individual and social responsibility, and sexual activity. Finally, vulnerability was explored through the fear of getting cervical cancer, the vulnerability experienced as part of screening, and the protection it was seen to offer. Choice, morality and vulnerability worked together to limit the available ways of experiencing and acting in relation to cervical screening, constructing compliance as the only option for women. Those who do not comply are positioned as problematic, irresponsible and immoral by women, their friends and families, and health professionals. This research highlighted the ways in which discourses produce realities which create and maintain power imbalances which govern and control women’s bodies. Rather than viewing cervical screening as a desirable yet morally neutral act which all women ought to participate in, it is a site where women may choose to comply or resist dominant discourses which exert power over women’s bodies.
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    Epidemiological studies of cervical cancer survival in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Epidemiology at Massey University, Wellington Campus, New Zealand
    (Massey University, 2011) Brewer, Naomi
    In this thesis I describe a series of studies of the stage at diagnosis and subsequent survival of women registered with cervical cancer in New Zealand during the period 1994 to 2005, and the factors that may contribute to the demographic differences that were found in both stage at diagnosis and survival. The studies involved all of the cervical cancer cases registered on the New Zealand Cancer Registry between 1994 and 2005. The cases were linked to the National Mortality Collection (for mortality data), the National Cervical Screening Programme- Register (for screening history), and the hospital events on the National Minimum Dataset (for information on comorbid conditions). The studies assessed what proportions of the ethnic differences in late stage diagnosis (after adjustment for socioeconomic position) were due to various factors such as screening history and urban/rural residency, and what proportions of the ethnic differences in survival (after adjustment for socio-economic position) were due to various factors including stage at diagnosis, comorbid conditions, and travel time and distance to the nearest General Practitioner and cancer centre. Māori and Pacific women had a higher risk of late stage diagnosis compared with ‘Other’ (predominantly European) women. Screening history did not entirely explain the increased risk in Māori women, but did explain that in Pacific women. More than half of the women with cervical cancer had not been screened, while those that had been ‘regularly’ screened had a considerably lower risk of a late stage diagnosis. Stage at diagnosis accounted for some but not all of the ethnic differences in survival. Comorbidity explained a moderate proportion of the ethnic differences in survival, while travel time may account for a small proportion of the ethnic differences in stage at diagnosis, and to a lesser extent mortality, particularly for Pacific women. The higher risk of late stage diagnosis in Māori women remains largely unexplained, whereas in Pacific women it is almost entirely due to differences in screening history and travel time. More than one-half of the higher risk of mortality in Māori and Pacific women is explained by differences in stage at diagnosis and comorbid conditions.