Does information inform? Societal dynamics of cancer screening: building on perception gap theory

Communicating the harms associated with participation in national screening programmes is not a straightforward process. In a previous study, we interviewed Danish women in the age group 23–55 and found that they tended to reject or downplay the harms presented in an information pamphlet related to cervical cancer screening. This phenomenon we termed the ‘Perception Gap’. In this article, we revisit the original data and draw on theoretical frameworks of governmentality and risk to elucidate the dynamics behind this perception gap. We found that the information material, itself, has minimal influence on how individuals understand and give meaning to the benefits and harms of screening. Instead, culturally and socially constructed logics of cancer and screening were essential to the women’s meaning-making of cancer screening. We argue that the perception gap emerges from governmental power, as participants were not passively governed, but internalised prevailing norms and aligned their attitudes with socially constructed expectations that position screening participation as the only responsible way to manage health. This leaves little room for individuals to pursue individual preferences that conflict with this collectively constructed notion. We found that non-participation itself was constructed as implying that the individual bears responsibility for potential burdens such as later development of cancer. We argue that the collectively constructed concepts of cancer and screening identified in this article, as well as how they are used in governance, need to be addressed and critically challenged before harms of screening can be effectively communicated and meaningfully incorporated into decision-making.