Sophie Mulcahy Symmons

Stakeholder perceptions of cervical screening accessibility and attendance in Ireland: a qualitative study

Abstract Organized cervical screening programmes are commonplace in high-income countries. To provide an equitable cervical screening service, it is important to understand who is and is not attending screening and why. Promotion of screening and service improvement is not possible without recognition and identification of the barriers and needs of communities that are less engaged with screening. This study explored stakeholder perceptions of cervical screening attendance and accessibility in Ireland. Semi-structured interviews were conducted with 12 healthcare professionals, policymakers and academics. Interviews were conducted online in 2022. Reflexive thematic analysis was used inductively to generate themes, supported by NVivo. Three themes were developed: (i) getting the right information out the right way, (ii) acceptability and accessibility of screening and (iii) trying to identify and reach the non-attenders. Participants felt public knowledge of cervical screening and human papilloma virus was low and communication strategies were not adequate. Individual, cultural, structural and service-level factors influenced the accessibility and acceptability of screening. Identifying and reaching non-attenders was considered challenging and community outreach could support those less likely to attend screening. Stakeholder perspectives were valuable in understanding the complexities of screening accessibility and attendance from individual to service-level factors. Cultural competency training, inclusive language and visual cues in waiting rooms would support engagement with some populations who may be hesitant to attend screening. Collaboration with community organizations has opportunities to promote screening and understand the needs of those less likely to attend screening.

Understanding the Influences of Cervical Screening Attendance among Women of Low Socioeconomic Position Using the Integrated Screening Action Model: A Qualitative Study

People of lower socioeconomic position have a higher incidence of cervical cancer and lower uptake of cervical screening. The Integrated Screening Action Model considers how an individual's environment, capability, opportunity, and motivation influence screening engagement. This study explored the influences of attending cervical screening among women of low socioeconomic position living in Dublin, Ireland, between those who are underscreened and regularly screened. Semistructured interviews were conducted with those who self-reported regularly attending screening or were underscreened, no university-level education, low-income employment or not working, aged 25 to 65 years, and living in Dublin. Participants were recruited via community organizations. A framework analysis was used to explore influences between regularly screened and underscreened participants. Sixteen participants were interviewed, and eight were underscreened. Regularly screened participants articulated their motivation to stay well, while underscreened participants appeared to avoid the potential of bad news, which was mediated by fear. Underscreened participants seemed to have limited social support and opportunity to consider screening, whereas regularly screened participants reflected that their peers supported them to attend, and in turn, they supported others (e.g., mothers being role models for daughters). The capability to attend screening was restricted for underscreened participants who often reported not knowing how to book a screening. The study highlights varied barriers and facilitators between those who are underscreened and regularly attend screening. Social opportunity was a major influencing factor in promoting screening and should be considered when designing interventions to promote screening in the community. Communications on screening must use understandable language. Understanding what is important to women when promoting screening uptake is essential to develop interventions that reflect their needs. Women appreciate reminders and trust information from health care professionals. Health care professionals may need training for opportunistic screening and to promote the availability of cervical screening in registered health care facilities.