Sonia Shpendi

Cervical screening attendance in young women and people with a cervix: An application of the COM ‐B model

Abstract Objectives Cervical cancer (CC), which is caused by the human papillomavirus (HPV), results in around 3000 new cancer cases yearly in the UK. According to recent figures, rates in the UK have increased by 13% in young women over the last decade; screening attendance has fallen to a 10‐year low. As the majority of women now reaching the screening age (24.5 years old) will be HPV vaccinated, research is needed to assess the possible impact of this successful immunisation programme on screening behaviours as well as to further our understanding of the current barriers and facilitators to screening and how these may differ between attendees and non‐attendees. Design Cross‐sectional survey. Methods Participants comprised 200 young women (attendees n  = 100, non‐attendees n  = 100) aged 25–30 years old living in the UK. Participants completed an online questionnaire assessing COM‐B model components and HPV vaccination status. Results A multiple logistic regression analysis revealed that reflective motivation was the only COM‐B component that was a significant independent predictor of screening attendance, such that higher reflective motivation scores increased the odds of having attended cervical screening. In addition, HPV‐vaccinated individuals had significantly greater odds of having attended screening when compared to non‐vaccinated individuals. Conclusions Reflective motivational factors are crucial in encouraging young women to attend CC screening. Future work should focus on developing interventions that enhance reflective motivation.

Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review

Background: Cervical cancer (CC) results in around 604,00 new cancer cases yearly and is caused by the human papillomavirus (HPV). Uptake rates for both the HPV vaccination and screening have been decreasing over recent years, particularly in young women, whilst CC remains a concern for both low- and high-income countries. Objectives: To highlight the key barriers and facilitators of CC screening attendance in young women and to identify the factors associated with their CC screening behaviour, to inform interventions to increase screening rates. Design: Systematic review. Data sources and methods: A systematic review was conducted using Scopus, Web of Science, MEDLINE, PsycINFO/PyscARTICLES and CINAHL. The review included primary qualitative, quantitative and mixed-method studies that reported barriers, facilitators and factors associated with current CC screening behaviours in women aged 30 or below. Outcomes were summarised narratively. Risk of bias was conducted for individual studies using the Mixed-Method Appraisal Tool. Results: Among the 106 studies included in the review, the most frequently reported barriers were financial constraints ( n  = 36), embarrassment ( n  = 35) and low accessibility to obtaining screening ( n  = 34). The most frequently reported facilitators were knowledge of CC ( n  = 12), healthcare provider recommendations ( n  = 11) and communication with friends ( n  = 11). Age (older), marital status (in a relationship) and sexual activity (active) were key factors associated with attendance at screening. Studies also highlighted that those vaccinated were more likely to have screened than those not vaccinated against HPV. Conclusion: These unique factors represent potential targets for interventions to increase CC screening attendance in young women. Future research could benefit from employing strong theoretical frameworks, such as the COM-B model of behavioural change, to categorise and gain further insight into the contributing factors affecting CC screening attendance. Registration: PROSPERO CRD42022324948.

Utilising the COM-B model to interpret barriers and facilitators to cervical cancer screening in young women

As most women now reaching the age for cervical cancer screening (24.5 years old) in the UK will be HPV vaccinated, their current perspectives on screening can inform effective interventions to increase screening uptake (and thus, early detection). Twenty-four interviews were conducted with women aged 24–30 years old to explore their views on cervical cancer screening ( n  = 12 attendees and n  = 12 non-attendees). Reflexive thematic analysis generated six themes that were then mapped onto the COM-B model. Reflective motivations (e.g. reassurance) were key facilitators to screening attendance for both groups. Social opportunities (e.g. open communication) contrasted between the groups, with attendees more likely to have discussed screening with friends. Automatic motivations (e.g. embarrassment) were key barriers to attending screening in both groups. Notably, HPV vaccination did not factor into the decision to attend screening. Interventions to increase screening uptake may target motivational and social factors.