New report identifies key barriers and enablers to cervical screening participation

Data shows that national uptake of cervical screening among younger women has fallen below 70%, impacting national targets to eliminate cervical cancer. To address the ongoing decline in cervical screening participation, it is important to understand the factors that discourage attendance and identify ways to improve uptake. An ARC East of England-funded report found that women's attitudes towards cervical screening are influenced by factors including feelings of vulnerability, worry, loss of control, uncertainty, and experiences of trauma.

Led by Lucy Jessup from Braintree Primary Care Network and Nikolett Hunyadvari from Mid and South Essex NHS Foundation Trust, this public involvement project worked with women from diverse cultural backgrounds, including those with lived experience of trauma and socioeconomic deprivation, to understand the factors influencing screening participation and identify ways to increase screening attendance. This project is part of an ongoing body of ARC East of England research aimed at addressing health inequalities faced by marginalised communities and improving women’s health.

Lucy Jessup, co-lead researcher for this project, shares the background to this work:

This pre-study was carried out in partnership with Braintree Primary Care Network and Research Engagement Network (REN), which supported the identification and recruitment of women who were overdue for cervical screening. Participants were recruited from areas across Essex, including Braintree, Colchester and Southend, as well as through the Centre for Action on Rape and Abuse (CARA) and the Multicultural Essex Women's Association (MEWA).

Researchers conducted both virtual and face-to-face focus groups to gather insights from women with a wide range of experiences, backgrounds and cultural beliefs that may influence participation in cervical screening. Women described feeling uncertain and lacking control over many aspects of the screening process, including understanding why it is important, what they should expect during the appointment, and what the results might mean. Many felt unable to ask for adjustments that could make the experience more comfortable. 

Women shared fears about feeling vulnerable and experiencing pain during the procedure. Previous healthcare experiences shaped women's views of cervical screening, with some reporting that their care had not always felt personalised or met their needs. Past experiences of sexual trauma were also identified as a barrier to participation. 

A key finding was the consistency of these concerns across very different groups of women, highlighting barriers that are rarely visible through routine data alone.

To address these barriers, the project has produced several recommendations to enhance care and increase cervical screening uptake. These include understanding common psychological barriers that can prevent women from engaging with cervical screening, so the screening is more accessible, personalised and supportive. Also, the need for a pre-appointment communication support package, which will address the concerns identified in the report. One recommendation is to focus on digital approaches to provide women with clear and accessible information, while supporting a more modern and responsive NHS. These recommendations will also be explored further in the future research project. 

The funding from the NIHR ARC East of England enabled meaningful engagement work with women whose voices are often underrepresented in research, particularly those from deprived communities and diverse ethnic backgrounds. Providing reimbursement for women’s time through the ARC funding was particularly significant given the sensitive nature of the topic and the potential barriers to involvement.

The research team is now developing a research bid in collaboration with Susan Walker, Associate Professor at Anglia Ruskin University, for a follow-on study to co-design and test a trauma-informed pre-appointment communication package aimed at improving cervical screening uptake among underserved women. Working closely with community members and healthcare staff, the study will explore how the intervention can be integrated into existing NHS services and assess its feasibility for wider implementation.

Read the report entitled ‘Summary for NIHR ARC, activities, learning, and impact - Improving Cervical Screening Uptake in Underserved Communities led by Braintree Primary Care Network’ here

For more information about the study and to find out more about the future project, please email Lucy Jessup at lucy.jessup1@nhs.net.