Objective-To identify the nature of pain and discomfort experienced during mammography and how it can be ameliorated.Design-Questionnaire survey before invitation for mammography and immediately after mammography. Responses before screening were related to experience of discomfort.Setting-Health district in South East Thames region.Subjects-1160 women aged 50-64 invited routinely for screening; 774 completed first questionnaire, of whom 617 had mammography. 597 completed the second questionnaire.Main outcome measures-Reported discomfort and pain, comparisons of discomfort with that experienced during other medical procedures, qualitative description of pain with adjective checklist.Results-35% (206/597) of the women reported discomfort and 6% (37/595) pain. 10 minutes after mammography these figures were 4% (24/595) and 0.7% (4/595) respectively. More than two thirds of women ranked having a tooth drilled, having a smear test, and giving blood as more uncomfortable than mammography. The most important predictor of discomfort was previous expectation of pain (discomfort was reported by 21/32 (66%) women who expected pain and 186/531 (35%) who did not). Discomfort had little effect on satisfaction or intention to reattend.Conclusions-The low levels of reported pain and discomfort shortly after mammography and the favourable comparisons with other investigations suggest that current procedures are acceptable. Since two thirds of the women experienced less pain than expected health education and promotion must ensure that accurate information is made available and publicised. IntroductionThe national breast screening programme is nearing the end of its first three year cycle. The success of the programme largely hinges on a high level of uptake and continued compliance by the target population, which in turn depends on whether the population finds the service acceptable. The University of Kent at Canterbury breast screening group recently completed a prospective study of more than 3000 women in three centres in the South East Thames region to examine users' responses to and satisfaction with the service.'

Travellers, or Gypsies, constitute a minority group with its own culture and traditions for whom access to health care can pose problems. A study of Traveller women and children showed that the sites where they lived were often lacking in facilities and provided a poor environment in terms of cleanliness and safety. Perinatal mortality was above average, and was especially high on sites with inadequate facilities and among the more mobile families. Immunisation and preventive care of children were both inadequate, especially among the more mobile. There continues to be a need for more, and better, permanent sites for Travellers. Other responses include allowing Traveller families to carry their own medical records, providing mobile clinics for Gypsy sites, and appointing specialist health visitors to ensure that Travellers get the health care to which they are entitled.Over the past few years there has been growing recognition that members of ethnic and cultural minorities may face particular barriers in getting access to appropriate health and welfare services. Local initiatives aimed at improving access have focused particularly on the needs of black and Asian communities (see Dowling, 1983). However, relatively little attention has been so far been given to the problems faced by Britain's oldest ethnic minority, the Gypsies, or Travellers, as they prefer to be known.The aims of the study described in this article were, firstly, to document the health problems of Traveller women and children and, secondly, to make recommendations for improvements in health and welfare services for this group of the population. Kent has a substantial population of Travellers, and so provided an opportunity for carrying out a study which would have relevance wherever Travellers share community

The objective of our study was to test whether attendance for breast cancer screening and satisfaction with the service could be predicted from a knowledge of the woman's social and psychological characteristics. In a prospective design, demographic characteristics, self-reported health status and behaviour, expectations and attitudes were examined through postal questionnaires sent out shortly before the invitation to screening, and the measures were used to predict subsequent attendance and satisfaction. The sample was taken from three areas in the South-East Thames Regional Health Authority providing a Forrest service--one rural, one provincial and one inner city--and consisted of 3160 women aged 50-64 invited routinely for screening. The main predictors of attendance were the woman's attitude to being screened and her belief that 'salient others' wanted her to attend. The main predictors of satisfaction with the service were the behaviour of the staff and the facilities at the centre. Three implications of the findings are discussed: (a) health education should include partners, relatives and friends of the target women, as their views had as much effect on attendance as did the women's attitudes; (b) staff training and development should focus on communication with the patient; (c) further research should examine the precursors of reported discomfort and pain.

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SUMMARY A three part investigation of the factors that might influence uptake of immunisation was carried out in Maidstone Health Authority; this included studies of the computer system and attitudes of parents and professionals. Several problems with immunisation scheduling, information transfer between general practitioners and clinics and the computer centre, and validity of computer information were identified. The attitudes of parents, relatives, and friends were generally favourable, although parents reported a lack of knowledge about the disease and vaccine and lack of advice from professionals. Perceived contraindications to immunisation, particularly a history of measles, were important reasons for non-uptake. Professionals