Cervical screening saves lives, but too many women, especially from minority and low‑income communities are still missing out, and this project laid the groundwork to understand the real barriers they face and identifying what support would genuinely help.
Background
Cervical cancer is largely preventable, yet uptake of cervical screening varies widely between communities. Some areas have particularly low screening rates, especially in more deprived neighbourhoods and in underserved groups. Lower uptake contributes to later diagnosis and potentially avoidable cancer deaths. Locally, initial PCN‑led work has already identified three deprived wards with consistently low screening participation and highlighted barriers women face in accessing screening. There is a clear need to better understand these inequalities and co‑develop more acceptable and accessible approaches to support screening uptake.
The insights and partnerships we built fed directly into an NIHR study, with the long‑term aim of creating approaches that could be scaled to reduce preventable cancers and improve health equity.
Project Aims
- Gathered early evidence and community insights that will support the development of a future NIHR-funded research study focused on improving cervical screening uptake.
- Worked with two contrasting PCNs - one already engaged (Braintree PCN) and one more ethnically diverse PCN, (Tilbury Chadwell PCN in Thurrock) - to better understand local inequalities, barriers, and what kinds of support women feel would help.
- Identified priority underserved groups and begin shaping potential components of a future co‑designed intervention.
Project Activity
- Cross-PCN collaboration established, including engagement with a second, more ethnically diverse PCN, strengthening system-wide learning and partnership working
- Baseline data mapping completed, including analysis of screening uptake and non-attendance patterns across local populations
- Three targeted PPIE workshops delivered with underserved groups (including multicultural women, those from socioeconomically deprived backgrounds and women who experienced sexual abuse and/or trauma)
- Ongoing engagement with NIHR Research Support Service (RSS) and academic collaborators to refine study design and funding strategy
- Development of candidate intervention concept, informed by PPIE insights, literature review, which is grounded in theory and appropriate behavioural frameworks
- Progression towards NIHR Research for Patient Benefit (RfPB) application, with collaborators, roles, and next steps established
Key Learning
- Barriers to screening are not solely explained by deprivation data – learning from detailed data analysis work by PA at Braintree PCN. Initial data suggested lower uptake in deprived areas; however, further analysis (including use of percentage non-attendance and deprivation scoring) and PPIE findings revealed that non-attendance is distributed across populations, with some less deprived groups showing equally low uptake.
- Psychological and experiential barriers are central drivers of non-attendance – learning from 3 workshops
- Current approaches largely focus on structural solutions, whereas there is a clear gap in interventions addressing these psychological and relational barriers.
Outputs
- A summary report describing local inequalities, barriers, and early priorities for intervention components.
- Stronger partnerships across PCNs, academia, NIHR infrastructure, and community members, ensuring any future research is grounded in lived experience and system need.
- A well‑prepared NIHR RfPB application, including evidence of acceptability, need, and feasibility gathered through this PPIE work.
- These outputs will address key gaps in understanding why screening inequalities persist locally and what community‑led solutions may be effective.
- Ultimately, the work lays the foundation for an evidence‑based, co‑designed intervention that could be scaled across the East of England to improve early detection and reduce avoidable cervical cancer deaths.
Impact
- Refined understanding of screening inequalities beyond traditional demographic assumptions, supporting more targeted and effective intervention design
- Strengthened cross-system collaboration, including new connections between PCNs, ICB stakeholders, and academic partners (the project has the full support of Cancer Leads in Essex ICB)
- Development of a novel, patient-informed intervention concept, addressing unmet needs identified through PPIE and literature
- Improved engagement model for underserved communities, including adaptation of reimbursement approaches (e.g. community and charity donations) to support inclusive participation
- Clear pathway to NIHR funding, with a co-designed feasibility study now being developed for submission
Next Steps
- Further workshops are planned to create the prototype intervention package
- Continued stakeholder and patient engagement
- Submission of NIHR RfPB application (July or November deadline depending on readiness and academic support)
Who was involved?
- Lucy Jessup, PI, Braintree PCN, Anglia Ruskin University
- Nikolett Hunyadvari - MSE ICB & Anglia Ruskin University
- MSE ICB REN
- Braintree PCN
- Tilbury Chadwell PCN
- MEWA CIC (multicultural Essex women association)
- CARA Essex Charity
Contact
Lucy Jessup - lucy.jessup1@nhs.net
