Exploring age differences in reasons for nonattendance for cervical screening: a qualitative study

Abstract

Objectives To explore differences in barriers to attendance at cervical screening across age groups because coverage of the cervical screening programme in England has been falling, particularly among women in the youngest age group (25-29 years).Design A qualitative study.Setting A university in London.Sample Professionals working in the screening field (n = 12) and women of varying ages who had either never attended for cervical screening or did not attend regularly (n = 46). MethodsIn Study 1 we interviewed professionals to elicit their views on the reasons for lower screening attendance in young women. In Study 2, we carried out four focus groups (n = 27) and 19 individual interviews with under-screened women to explore their barriers to attendance. Verbatim transcripts were analysed using Framework Analysis.Results Reasons for nonattendance were many and varied. Health professionals identified population-level factors, service provision issues, time pressures, risk perceptions, lack of knowledge and psychological barriers. The nonattenders fell into two groups: those who had made an active decision not to take part (who tended to be older), and those who intended to be screened but did not attend (predominantly younger women). Practical barriers were raised more often by younger women whereas older women had more negative attitudes to screening.Conclusion This study provides rich data on the complex reasons why women do not attend for cervical screening. It points to age differences in barriers to screening, and suggests that addressing practical issues such as appointment systems and clinic times may have a positive impact on attendance in young women.

Increasing participation in cervical cancer screening: Telephone contact with long‐term non‐attendees in Sweden. Results from RACOMIP, a randomized controlled trial

“…Practical obstacles dominated, as seen in other studies, [30][31][32] especially among young women. 33 The most common special request was for a convenient appointment and more than half actually booked outside the regular screening schedule. This may be a manifestation of poor accessibility in the regular screening program and scheduling of appointments can no doubt be improved.…”

Psycho-social influences upon older women's decision to attend cervical screening: A review of current evidence

“…Embarrassment and perceived indignity are often cited by older women as important barriers to screening (Armstrong, 2007;Van Til et al, 2003;Waller, Bartoszek, Marlow & Wardle, 2009;Waller, Jackowska, Marlow & Wardle, 2012;White, 1995). Embarrassment when requesting an appointment and anxiety prior to screening can be severe (Van Til et al, 2003;Armstrong, 2007).…”

“…However, Waller et al, (2012) conducted a qualitative study with British women and found that older women were more concerned with emotional barriers such as embarrassment or fear rather than logistical issues compared to their younger counterparts. Logistical barriers may be more resonant among younger women for example due to moving address more often .…”

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

“…Some women, particularly those who have experienced abuse 14 or are otherwise marginalized, may find self-sampling preferable because of such things as cultural/religious embarrassment or discomfort associated with a pelvic exam 13,[15][16][17] . Time, transportation, inconvenient clinic hours, or not having a regular practitioner are also relevant factors associated with under-screening that can be mitigated through hpv self-collection using mailed samples 13,16,17 . However, there are psychosocial barriers to hpv screening, including women's lack of awareness and fears around hpv and cervical cancer screening, which cannot be addressed through self-collection-based screening alone 17,18 .…”