Understanding the barriers contributing to 'missingness' of patients from deep-end practices within the cervical smear screening programme.

Abstract

Background: The Cervical Smear Programme in the UK is crucial for early detection of cervical cancer and screening for human papillomavirus (HPV). However, participation remains below targets with 65.8% of eligible women aged 25-49 years engaging as of December 2023, this disproportionately affects the most at-risk individuals.

Aim: This cross-sectional survey aimed to identify barriers in deep-end GP practices preventing participation in cervical screening and develop strategies to reduce 'missingness', a term describing the tendency to disengage from healthcare despite offers of care.

Method: 401 patients were identified using the Scottish Cervical Call Recall System, at a deep-end GP practice who had recently defaulted from their smear. From this, 54 patients were selected: those who had either previous abnormal results or defaulted 4 or more smears.

Results: The survey identified several barriers to participation, including mental health issues, fear related to previous abnormal results, work commitments, and health illiteracy. Specific concerns included difficulties scheduling around work or caregiving responsibilities and anxiety related to the process with some expressing misunderstandings regarding the safety of the smear test.

Conclusion: Overcoming these barriers requires tailored interventions, such as flexible appointment scheduling, increased education on the importance of cervical screening, and opportunistic screening during other healthcare visits. Addressing these barriers could improve participation rates and reduce health disparities. The survey has limitations in the form of small sample size and time constraints. There is a need for further research with a larger group to validate these findings.