Monjura Nisha

The role of non-medical providers in increasing access to cervical screening: a scoping review

Introduction Involving non-medical providers (NMPs) in cervical screening interventions could be a promising strategy to increase cervical screening participation among never or underscreened populations. We undertook a scoping review of published literature to explore the potential role of NMPs in increasing cervical screening participation. Methods We searched three databases (MEDLINE, EMBASE and CINAHL) to identify relevant scientific research articles published between 2016 and 2024 and extracted data using a standardised extraction tool. Results Our review identified 35 studies (randomised controlled trials (RCTs): n=12, non-RCTs: n=23) from a breadth of geographical and country-level income settings including Australia and New Zealand (n=3), Africa (n=7), Asia (n=4), Europe (n=3) and North (n=15) and South (n=3) America. NMPs in the included studies were community health workers, nurses and midwives; and their key roles involved identifying and recruiting target populations, delivering health education and raising awareness of cervical screening, facilitating self-sampling and providing navigation and follow-up assistance. Most studies included screening participants aged ≥30 years, who were underscreened, not pregnant, from ethnic minority populations, and living in rural or remote communities. NMP-facilitated cervical screening interventions were largely feasible and acceptable among target populations. Compared with the standard of care, which did not involve NMPs, NMP-facilitated interventions generally demonstrated an increased uptake of cervical screening in RCTs (n=11 out of 12) with relative increases ranging from 1.11 to 42.73. In four RCTs, where NMPs facilitated self-sampling, cervical screening uptake rates ranged from 32.0% to 81.0%. Most non-RCTs (n=18) involved NMPs in facilitating self-sampling, with screening uptake rates ranging from 9.0% to 100.0%. Key strategies identified were capacity-building of NMPs through training, and employing outreach strategies to reach underscreened women. Conclusion NMPs could play a wider and an important role in cervical screening, particularly in the context of self-sampling and have the potential to increase access and equity in cervical screening.

Participation in the National Cervical Screening Program Among Women Who Gave Birth in New South Wales, Australia by Place of Maternal Birth: A Data Linkage Analysis

ABSTRACT Objective High participation rates in the National Cervical Screening Program (NCSP) by all groups of women are required to ensure the equitable elimination of cervical cancer in Australia. In this study, we examine screening participation of overseas‐born women compared to Australian‐born women who gave birth. Design Population‐based retrospective cohort study using linked health datasets. Setting and Participants Women who gave birth in New South Wales between January 1, 2000 and June 30, 2017. Main Outcome Measures Participation in the NCSP (≥ 1 cytology test) in the 3‐ and 5‐year periods prior to delivery by place of maternal birth, adjusted for multiple socio‐demographic and health characteristics. Results Among the 1 332 669 mothers who gave birth over the study period, overall cervical screening participation in the 3‐ and 5‐year periods prior to delivery was 67.0% and 75.7%, respectively. Participation was lower for overseas‐born mothers compared to Australian‐born mothers for both the 3‐year (57.8% vs. 71.7%; adjusted odds ratio [aOR]: 0.51, 95% confidence interval [CI]: 0.50–0.51) and 5‐year (64.9% vs. 81.2%; aOR: 0.40, 95% CI: 0.40–0.40) participation periods. All groups of overseas‐born women had substantially lower screening participation compared to Australian‐born women, with the lowest relative 3‐year participation in mothers born in Southern/Central Asia (aOR: 0.30, 95% CI: 0.30–0.31), Oceania (aOR: 0.31, 95% CI: 0.30–0.32), North‐East Asia (aOR: 0.49, 95% CI: 0.48–0.50), and New Zealand (aOR: 0.49, 95% CI: 0.48–0.51). Conclusions Overseas‐born women had around half the cervical screening participation in the period prior to birth compared to Australian‐born women. It is likely that opportunities to screen these under‐screened groups during the antenatal period, typically a time of repeated health services contact, are missed.