Screen to be seen: An empirical survey study investigating the barriers and facilitators of women in the UK attending cervical screening

Abstract

Background: The proportion of women in England who have not attended cervical screening has reached its highest level in a decade. This study explores the barriers women encounter and the factors that can facilitate cervical screening attendance. Additionally, it examines whether knowledge of cervical screening is a predictor of attendance. 

Methods: Participants were recruited through a voluntary online survey questionnaire. The Health Belief Model was utilised as a theoretical framework to measure attitudes and behaviours linked to cervical screening. 

Results: Significant age-related differences were observed: a higher proportion of younger women (aged 25-54) agreed that they intended to attend screenings as scheduled but didn’t get around to it straight away, compared to their older counterparts (aged 55 and over). The same pattern was observed regarding agreement with the statements about difficulties in securing appointments due to work or childcare commitments and the recommendation of cervical screening for women their age. Conversely, a higher proportion of older women agreed that they had a bad experience with smear tests in the past compared to the younger counterparts. Significant associations were found relating to concerns about pain and fears regarding what a smear test might reveal. These included having had a bad experience with a smear test, feeling reassured when finding out that everything is okay, and having had a previous positive experience of a smear test. Common barrier themes identified included emotional and psychological factors, as well as issues related to healthcare professionals, GP surgeries, GP receptionists, and difficulties in securing appointments. Conversely, common facilitator themes identified included health beliefs, followed by reminders and a desire for policy change. 

Conclusion:  The study highlighted several major obstacles which impacted women’s participation in cervical screening. To enhance cervical screening participation, government policies should focus on health promotion campaigns which include how health beliefs can influence attendance.