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

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusion

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.

Implications for Practice

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.