ARC GM | Projects

What were we trying to do?

We aimed to identify key factors (from general practice and patients) which might be associated with cervical screening attendance in England between 2013 and 2022.

We also wanted to understand experiences during, and barriers to, attending cervical screening (also known as ‘smear tests’) among groups who typically attend screening less than the general eligible population.

We also wanted to explore their views towards self-sampling (vaginal swabbing and urine sampling) as alternative screening methods, to understand how this may address existing barriers to cervical screening.

Why was this important?

Cervical cancer remains an important global public health concern. Attendance at cervical screening in England has fallen in recent years, especially since the pandemic. Understanding why there has been a decline in screening uptake in high-income countries is fundamental to improving screening rates.

There were (and still are) clear differences in cervical screening attendance for different groups according to factors such as health, income, ethnicity and age.

Previous research looking into barriers to screening for underserved and marginalised groups focused on why people might not attend the routine method of healthcare practitioner-taken cervical samples (the ‘smear test’).

Recent developments on the potential use of self-sampling methods for cervical screening, including vaginal and urine sampling, provide a potentially less intrusive method. However, research was needed to explore how this may address inequalities in screening uptake for different groups.

How did we do it?

We analysed data on cervical screening attendance rates from a panel of GP practices over a nine-year period. We used statistical analysis methods to explore a range of patient and GP practice characteristics to see whether these were associated with cervical screening attendance rates.

Working in partnership with community stakeholders, we conducted interviews and focus groups with 46 participants, aided by collaborations with the Voluntary, Community and Social Enterprise (VCSE) sector which helped us to reach under-served communities.

Out of the 46 participants:

46% had attended cervical screening and/or could be considered ‘regular attenders’
just under one-third had never attended, had missed at least one screening opportunity, and/or were not planning to attend again
9 participants did not discuss their screening status.

Findings

Our results show a decline in overall screening rates from 2013/14 to 2021/22 from 77% to 72%. Reasons for this related to:

the general practice workforce
the number of patients registered with the practice
the location – GP practices in poorer areas had lower screening rates.

While there are ongoing barriers to cervical screening for under-screened participant groups, we also found numerous examples of good practice where some participants' needs were met throughout the screening process:

Both positive and negative experiences tended to centre around experiences with healthcare professionals - negative experiences also centred around the use of the speculum.
Self-sampling methods (vaginal swab and urine collection) were positively received by participants, and could reduce existing barriers by providing more choice.
The removal of the speculum and lack of invasive examination by a healthcare professional was positively received.

In conclusion, GP workforce and patient characteristics need to be considered by decision-makers to increase screening rates. The use of self-sampling screening methods could help address some of the current barriers to screening, including lack of healthcare staff and facilities.

Examples of good practice should be used more widely to ensure consistency in patient experience and to make sure the needs of under-served groups are better met.

The introduction of self-sampling alongside traditional methods may reduce barriers to screening and could boost screening rates for under-screened groups. However, they must be launched alongside appropriate information and sufficient communication.

Research leads

Stephanie Gillibrand (Co-Principle investigator)
Prof. Caroline Sanders (Co-Principle investigator)
Prof. Emma Crosbie (Co-investigator)
Dr. Jen Davies-Oliveria (Co-investigator)

Who did we work with?

We worked with community members within areas of Greater Manchester where uptake is low in order to work together on the research plans, helping us to design appropriate information for study participants.

We also worked together to analyse, present and write about the findings.

Funding information

This research study is funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research, FR5, Project ID: 611. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Downloadable resources

More information

Senior Programme Lead
Mike Spence
mike.spence@healthinnovationmanchester.com

Barriers to cervical screening for under-screened individuals