Exploring the barriers to cervical screening and perspectives on new self-sampling methods amongst under-served groups.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Uterine Cervical Neoplasms*/diagnosis ; Early Detection of Cancer*/methods ; Vaginal Smears*/methods ; Self Care*/methods ; Health Services Accessibility* ; Patient Acceptance of Health Care* ; Mass Screening*/methods; Humans ; Female ; Adult ; Middle Aged ; Focus Groups ; Qualitative Research ; United Kingdom ; Specimen Handling/methods ; Interviews as Topic

Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by NHS HRA West Midlands—Black Country Research Ethics Committee 01/02/23 IRAS319639 REF:22/WM/0269. Informed consent to participate in the research was taken from all research participants ahead of their participation in the study. Consent to participate in the study was taken from each participant by a member of the research team. All experiments were performed in accordance with relevant guidelines and regulations. Consent for publication: Dual publication the results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher. Competing interests: The authors declare no competing interests.
Background: Cervical screening rates have fallen in recent years in the UK, representing a health inequity for some under-served groups. Self-sampling alternatives to cervical screening may be useful where certain barriers prohibit access to routine cervical screening. However, there is limited evidence on whether self-sampling methods address known barriers to cervical screening and subsequently increase uptake amongst under-screened groups. Addressing this research gap, the study aims to understand experiences during and barriers to attending cervical screening for under-screened groups and; explore the views of individuals eligible for screening towards self-sampling (vaginal swabbing and urine sampling) as alternative screening methods and how this may address existing barriers to screening.
Methods: We draw on three integrated theoretical frameworks (access to primary care services, intersectional and feminist perspectives) to examine participants' barriers to screening and views toward self-sampling methods. We undertook primary qualitative data collection (interviews and focus groups) with 46 participants, facilitated by collaborations with the VCSE sector which successfully enhanced reach to under-served communities.
Results: Known barriers to cervical screening persist for under-screened participant groups, but we also find numerous examples of good practice where some participants' needs were met throughout the screening process. Both positive and negative experiences tend to centre around experiences with healthcare professionals, with negative experiences also centring around the use of the speculum. Self-sampling methods (vaginal swab and urine collection) were positively received by participants, and may address some existing barriers through the proponents of enhanced choice - between method and location (which also dovetailed with convenience) leading to greater empowerment. The removal of the speculum and lack of invasive examination by a healthcare professional was also positively received.
Conclusions: Whilst barriers to cervical screening remain for under-served groups, examples of good practice are prevalent. Such examples should be implemented more widely to ensure consistency in patient experience and to ensure needs are better met for under-served groups. The introduction of self-sampling alongside traditional methods may reduce barriers to screening, and may boost screening rates for under-screened groups but only if they are implemented with appropriate information and sufficient communication. Failure to implement self-sampling without these considerations may threaten to undermine the identified and important benefits of self-sampling methods.
(© 2025. The Author(s).)

Psychooncology. 2017 Feb;26(2):161-172. (PMID: 27072589)
BMC Med Res Methodol. 2013 Sep 18;13:117. (PMID: 24047204)
Int J Environ Res Public Health. 2021 Jul 24;18(15):. (PMID: 34360140)
BMJ. 1999 Sep 18;319(7212):774-8. (PMID: 10488012)
Psychooncology. 2018 Oct;27(10):2488-2493. (PMID: 30095862)
Soc Sci Med. 2006 Jun;62(12):2998-3010. (PMID: 16403597)
Br J Gen Pract. 2024 Jan 25;74(739):e104-e112. (PMID: 38253550)
BMJ Open. 2019 Apr 29;9(4):e025388. (PMID: 31036707)
J Clin Nurs. 2022 Jun;31(11-12):1588-1597. (PMID: 34418192)
BMJ. 2023 Nov 15;383:2693. (PMID: 37967919)
J Public Health (Oxf). 2024 Feb 23;46(1):e43-e50. (PMID: 38148290)
Eur J Cancer Care (Engl). 2011 Nov;20(6):720-7. (PMID: 21521388)
Gynecol Oncol. 2021 Sep;162(3):575-583. (PMID: 34172287)
Soc Sci Med. 2001 Nov;53(9):1149-62. (PMID: 11556606)
Pathogens. 2023 Feb 11;12(2):. (PMID: 36839570)
Br J Gen Pract. 2009 Aug;59(565):e260-6. (PMID: 22751251)
BMC Womens Health. 2021 Mar 23;21(1):122. (PMID: 33757512)
Br J Gen Pract. 2015 Nov;65(640):606-7. (PMID: 26500315)
Br J Cancer. 2015 Sep 1;113(5):833-9. (PMID: 26171938)
BMC Womens Health. 2019 Feb 26;19(1):38. (PMID: 30808349)
BMJ. 2000 Jan 8;320(7227):114-6. (PMID: 10625273)
Sociol Health Illn. 2015 May;37(4):545-60. (PMID: 25682852)
BJOG. 2012 Jan;119(1):26-32. (PMID: 21668764)
Nurs Inq. 2014 Mar;21(1):11-9. (PMID: 23336250)
Soc Sci Med. 2000 Feb;50(3):429-44. (PMID: 10626766)
Health (London). 2007 Jan;11(1):69-85. (PMID: 17158832)
Womens Health (Lond). 2021 Jan-Dec;17:17455065211029238. (PMID: 34225506)
Soc Sci Med. 1985;20(9):911-21. (PMID: 4012367)
BMC Womens Health. 2011 Sep 28;11:43. (PMID: 21951661)
Br J Cancer. 2021 Apr;124(8):1361-1365. (PMID: 33558708)
J Med Screen. 2018 Dec;25(4):211-217. (PMID: 29649936)
J Health Serv Res Policy. 2008 Apr;13 Suppl 2:3-10. (PMID: 18416923)
Lancet Public Health. 2021 Jul;6(7):e522-e527. (PMID: 33939965)
Br J Nurs. 2008 Apr 24-May 7;17(8):518-25. (PMID: 18563025)
Soc Sci Med. 2018 Mar;200:92-98. (PMID: 29421476)
Br J Gen Pract. 2022 Apr 28;72(718):e342-e350. (PMID: 34990392)
Int J Equity Health. 2013 Mar 11;12:18. (PMID: 23496984)
J R Soc Med. 2016 Jul;109(7):274-81. (PMID: 27118696)
Public Health. 2009 Oct;123(10):680-5. (PMID: 19863980)
Health Psychol Behav Med. 2020 Aug 7;8(1):314-328. (PMID: 34040874)
J Fam Plann Reprod Health Care. 2012 Oct;38(4):214-20. (PMID: 23027982)
Curr Pharm Teach Learn. 2018 Jun;10(6):807-815. (PMID: 30025784)
Br J Gen Pract. 2024 Sep 26;74(747):e683-e694. (PMID: 38936884)
BMJ. 2014 Sep 16;349:g5264. (PMID: 25232064)
BMJ Open. 2023 Jun 6;13(6):e068940. (PMID: 37280031)
J Fam Plann Reprod Health Care. 2015 Oct;41(4):248-54. (PMID: 25583124)

Keywords: Cervical screening; Intersectionality; Self-sampling; Under-served groups

Date Created: 20250114 Date Completed: 20250501 Latest Revision: 20250501

20250501

PMC11734453

10.1186/s12913-024-12098-2

39810153