Nurses play a crucial role in delivering cervical screening. Louise Ansari, chief executive of Healthwatch England, says that it’s essential to understand the latest research into women’s views and experiences as uptake for screening continues to fall.
Nurses play a vital role in delivering cervical screening. With NHS England’s ambition to eliminate cervical cancer by 2040, their role becomes even more critical.
However, a key challenge is decreasing uptake — last year’s data shows that nearly a third of eligible women in the country didn’t attend their screening appointments.
To identify uptake solutions and support NHSE’s goal, Healthwatch England conducted a national poll of 2,444 women who were hesitant about attending their next cervical screening appointment and 30 in depth interviews with women with diverse characteristics.
Trends in hesitancy
Our poll found the top reasons for screening hesitancy were worries about physical discomfort, embarrassment at undressing in front of healthcare professionals, and also believing they didn’t need it because they weren’t currently sexually active.
However, the findings differed among respondents. Nearly half (44%) of young women aged 24-29 were more worried about feeling physical discomfort than 31% of women aged 60-64. This was also a greater concern for disabled women (43%) than for non-disabled women (36%).
Women of Asian heritage were more likely (30%) than White (26%) or Black (20%) women to say one reason for their hesitancy was embarrassment at undressing in front of a healthcare professional.
In contrast, women of African heritage were more likely (30%) than Asian (26%) or White women (20%) to think they didn’t need to attend their cervical screening appointment as they were not sexually active.
Past experiences
More than half of the women we polled had attended screening previously, and most of this group (81%) said staff had treated them with respect. However, only a third (33%) felt they’d been able to ask staff for practical changes that could make them feel comfortable.
Interviewees described why this support is essential, such as this young woman in Central Bedfordshire, who said: ‘I know for a fact, what really helped me last time when I went was that the nurse, after it had been done, told me the specific speculum that would suit my cervix the best for the future.’
Sensitive staff
Our poll asked women to consider what would encourage them to attend their next cervical screening appointment. Of the 11 options, the most (62%) chose ‘staff who are sensitive to my worries about the examination and previous experiences’.
This theme also came up in interviews, especially among women who had been anxious about pain, fearful due to past trauma or were disabled.
A woman who has a learning disability told us about the impact of a lack of tailored care, saying: ‘They insert the clamp too fast, without no warning. This also makes me extremely anxious’.
At a subsequent appointment, the same woman said she had a ‘very comfortable’ experience because it was delivered by a familiar health professional who explained the procedure ‘step by step’.
Knowledge and misconceptions
Lack of awareness and misconceptions play their part in affecting women’s hesitancy about cervical screening.
Our poll showed that the vast majority of women (78%) felt NHS information explained the purpose of cervical screening. However, only 56% felt the same about information about HPV. Lack of awareness about HPV can leave some women not knowing how it is spread or how long it can remain in their body.
Some women we interviewed had been born in countries without any national screening programme or where topics like cancer were ‘taboo’, so their first knowledge of screening might be through friends.
Women might also be affected by family or cultural beliefs. A young woman told us: ‘There’s a lot of people who think that you shouldn’t be inserting things into your vagina before marriage because of the whole hymen thing’.
To help overcome misconceptions and answer questions, nurses in some parts of England have worked with local Healthwatch to reach diverse women. This has included an information workshop hosted by Healthwatch Islington, in which a nurse spoke with staff from organisations supporting women from minority ethnic backgrounds. And through the Rumworth Project, led by Healthwatch Bolton, GPs, a primary care network, a cancer charity, and local mosques have run outreach clinics to help women get information about screening in familiar environments.
Personalising the approach to every woman’s needs
As well as sensitive staff and better knowledge, our new report calls for:
- Accessible screening invitation letters and leaflets;
- Adjustments for disabled women;
- An NHS-wide policy on chaperones;
- NHS-branded trauma cards for women to show staff;
- Self-screening kits available free on the NHS as an alternative option for hesitant women;
- More flexible appointment times or drop-in clinics;
- Better national data collection on the demographics of women who don’t attend.
Together, these factors should deliver the personalised approach women seek to reduce embarrassment, discomfort, fear or shame, and protect their gynaecological health.
