Abstract
ABSTRACT Objective: Cervical cancer is the fourth most commonly occurring cancer in women worldwide. The UK has one of the highest cervical screening rates in Europe, yet attendance has been decreasing. This study aimed to identify barriers and facilitators to screening attendance and assess the perceived importance of these factors. Methods: 194 women living in the UK were recruited via an online research recruitment website to an online survey. Most participants (N = 128, 66.0%) were currently up-to-date with cervical screening, 66 participants (34.0%) had never been screened, or were overdue for screening. Participants identified barriers and facilitators to cervical screening attendance via free-text responses and were also asked to rate a list of factors as most to least influential over decision making. Results were analysed using thematic content analysis and ratings analysed using multivariable analyses. Results: The most commonly reported barriers were: Pain/discomfort; Embarrassment; and Time. These were also rated as most influential for decision making. The most commonly reported facilitators were: Ease of making appointments; Peace of mind; and Fear of cancer/preventing serious illness. While importance rating of barriers did not differ by previous screening behaviour, ratings of some facilitators significantly differed. Up-to-date women rated believing screening is potentially life-saving and part of personal responsibility as significantly more important than overdue/never screened women. Conclusion: This study confirmed that factors which encourage screening are key to the decision of whether to attend screening. Women suggested several improvements that might make attending easier and improve uptake, including flexibility of screening locations to fit around work hours and childcare arrangements. Psychological facilitators included the peace of mind that screening brings and the belief that cervical cancer screening is potentially life-saving. Public health interventions should target factors which facilitate screening and how these interplay with barriers in order to improve uptake.
Highlights
Cervical cancer is the fourth most common cancer to occur in women worldwide (World Health Organisation, 2018)
The National Health Service (NHS) cervical screening programme in the UK routinely sends invitations, re-invitations and reminders to take part in the screening to eligible women, while appointments are organised with their local general practitioner
A wide range of influential factors have been identified in previous research, many of these are identified by both attenders and non-attenders. It is unclear whether some factors are more influential over decision-making or whether there are key differences in the barriers and facilitators identified by up-to-date vs. non-attenders/women overdue for screening
Summary
Cervical cancer is the fourth most common cancer to occur in women worldwide (World Health Organisation, 2018). One qualitative study using face to face and online focus groups to explore what factors encourage 30-year-old Swedish women to engage in cervical cancer screening found a range of factors were considered to facilitate screening in a group of 138 women, including invitations to screening and reminder letters along with providing a more individualised screening process (Blomberg et al, 2010). Using an anonymous, online survey method targeting a wide range of women in terms of age, socioeconomic deprivation, and past screening behaviour, the study aimed to qualitatively assess the barriers and facilitators in a sample not limited by these key characteristics. It is unclear whether some factors are more influential over decision-making or whether there are key differences in the barriers and facilitators identified by up-to-date vs. non-attenders/women overdue for screening
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