Factors influencing the participation of groups identified as underserved in cervical cancer screening in Europe: a scoping review of the literature

Abstract

BackgroundCervical cancer is a preventable and inequitably distributed disease. Screening plays a vital role in prevention, but many women face barriers to participation. The aims of this scoping review, undertaken to inform the co-design of interventions to equitably increase screening uptake, were to: (1) identify barriers and facilitators to cervical cancer screening for underserved populations, and (2) identify and describe the effectiveness of interventions aimed at improving participation in cervical cancer screening among underserved groups in Europe.MethodsQualitative, quantitative, and mixed methods studies focusing on barriers and facilitators to cervical screening participation and interventions to improve uptake undertaken in Europe and published after 2000 were included. Four electronic databases were searched to identify relevant papers. Titles and abstracts were screened, full text reviewed, and key findings extracted. Data were extracted and analyzed according to different health system strata: system-wide (macro), service specific (meso) and individual/community specific (micro). Within these categories, themes were identified, and the population groups impacted were recorded. All findings are presented in accordance with (PRISMA) guidelines.Results33 studies on barriers and facilitators and eight intervention studies met the inclusion criteria. Collectively, the findings of these studies presented a wide array of screening uptake barriers, facilitators, and interventions, predominantly related to screening service and individual/community factors. However, although diverse, certain core themes around information provision, prompts for participation and the need for inclusive spaces were apparent. Implementation of screening programs should focus on: (1) reducing identifiable barriers, (2) increasing public awareness, and (3) providing patient reminders and measures to promote engagement by healthcare providers.ConclusionThere are many barriers to uptake of cervical cancer screening and this review, nested within a larger study, will inform work to devise a solution alongside groups identified in three European countries.

What are the barriers towards cervical cancer screening for vulnerable women? A qualitative comparative analysis of stakeholder perspectives in seven European countries

“…This is supported by an American study which found that high-risk and low-income groups have a much lower engagement in standard preventive healthcare services than other groups. 41 The systematic review conducted within the CBIG-SCREEN project 6 identified several reasons for vulnerable women’s low priority of preventive healthcare including childcare, work, pressure following substance abuse, complex migration processes and low self-esteem.…”

“…Feelings of shame connected to CCS are a well-known barrier for women regardless of nationality and SES. The linked systematic review 6 found that embarrassment and fear of stigma were perceived as barriers to attendance in CCS for subgroups of vulnerable women in 18 of 33 articles. In a UK population-based survey, Waller et al 42 found that, in general, embarrassment was the most common barrier to attendance.…”

“…22 of the studies came from stakeholder perspectives on different decisional levels. 6 The importance of including the perspectives of the most underserved populations in research has long been recognised. 7 The scoping review showed that most of the studies elicit women's perspectives from ethnic minority or migrant groups (n=20).…”

Meeting the challenges of the 21st century: the fundamental importance of trust for transformation

“…HPV testing, based on self-sampling, offers a possible response for disadvantaged women who are not reached by screening programmes. An ongoing study is working with such women in several countries in Europe to find solutions that meet their needs [ 47 ]. This can be as simple as finding a way that they can return samples when the postal system does not work.…”