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This paper reports an examination of cognitive processes used by 178 women aged 50 years and older in retrieving information about the frequency with which they received Papanicolaou smears, mammograms, and clinical breast examinations. Women were selected from a health maintenance organization in which they had been enrolled for at least 5 1/2 years. The literature suggested that reporting of regular events such as these kinds of tests is likely to be based on schemas, which is an estimation technique in which events are reported in a format with generic content. Thus, if the procedure is believed to occur annually, the respondent will report receiving five tests in 5 years. The study attempted to evaluate whether use of episodic recall, in which respondents are forced to report individual events, would be more accurate than reports based on estimation using a schema format. The results indicated that most of the errors occurred in Papanicolaou smear reporting, which is consistent with the literature, and that the fewest errors occurred with mammograms. Regardless of the questionnaire format, respondents persisted in using schemas based on the date of annual physical examination. Most reporting errors occurred because the interval between examinations was estimated incorrectly.

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We evaluated 4 approaches to improving the reporting of disease prevention and screening behaviors. The conditions evaluated include (1) the mode in which data are collected, (2) asking the interview subject about her intention to obtain the procedure before asking whether the behavior occurred, (3) asking the interview subject about barriers that might keep respondents from getting the procedure before asking about whether she has received it, and (4) asking the interview subject about exceptions to the regularity with which she might report getting the examination. Data were collected in 2001 from a sample of women aged 50 and older in Champaign-Urbana, Illinois. After completing a telephone or audio computer-assisted self-interview (ACASI), respondents gave permission to abstract their medical records to validate self-reports of Papanicolaou tests, mammograms, and clinical-gynecologic examinations received during the past 3 years. Interviews and matching medical records were available for 588 respondents. Results indicated that first asking about future intentions may be an important design feature that warrants additional consideration. In addition, the use of ACASI may lead to lower quality reporting among women with little computer experience. This study represents the only research to date that reports experimental attempts to address the social desirability biases commonly found in the reporting of cancer screening behaviors.

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