Gillibrand Stephanie, Gibson Helen, Howells Kelly, Urwin Sean, Davies Jennifer C, Crosbie Emma J, Sanders Caroline
Centre for Primary Care & Health Services Research, School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Greater Manchester, England, UK.
NIHR Greater Manchester Patient Safety Research Collaboration, Centre for Primary Care & Health Services Research, School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Greater Manchester, England, UK.
BMC Health Serv Res. 2025 Jan 15;25(1):79. doi: 10.1186/s12913-024-12098-2.
Cervical screening rates have fallen in recent years in the UK, representing a health inequity for some under-served groups. Self-sampling alternatives to cervical screening may be useful where certain barriers prohibit access to routine cervical screening. However, there is limited evidence on whether self-sampling methods address known barriers to cervical screening and subsequently increase uptake amongst under-screened groups. Addressing this research gap, the study aims to understand experiences during and barriers to attending cervical screening for under-screened groups and; explore the views of individuals eligible for screening towards self-sampling (vaginal swabbing and urine sampling) as alternative screening methods and how this may address existing barriers to screening.
We draw on three integrated theoretical frameworks (access to primary care services, intersectional and feminist perspectives) to examine participants' barriers to screening and views toward self-sampling methods. We undertook primary qualitative data collection (interviews and focus groups) with 46 participants, facilitated by collaborations with the VCSE sector which successfully enhanced reach to under-served communities.
Known barriers to cervical screening persist for under-screened participant groups, but we also find numerous examples of good practice where some participants' needs were met throughout the screening process. Both positive and negative experiences tend to centre around experiences with healthcare professionals, with negative experiences also centring around the use of the speculum. Self-sampling methods (vaginal swab and urine collection) were positively received by participants, and may address some existing barriers through the proponents of enhanced choice - between method and location (which also dovetailed with convenience) leading to greater empowerment. The removal of the speculum and lack of invasive examination by a healthcare professional was also positively received.
Whilst barriers to cervical screening remain for under-served groups, examples of good practice are prevalent. Such examples should be implemented more widely to ensure consistency in patient experience and to ensure needs are better met for under-served groups. The introduction of self-sampling alongside traditional methods may reduce barriers to screening, and may boost screening rates for under-screened groups but only if they are implemented with appropriate information and sufficient communication. Failure to implement self-sampling without these considerations may threaten to undermine the identified and important benefits of self-sampling methods.
近年来，英国的宫颈癌筛查率有所下降，这对一些服务不足的群体来说意味着健康不平等。在某些障碍阻碍人们进行常规宫颈癌筛查的情况下，宫颈癌筛查的自我采样替代方法可能会有所帮助。然而，关于自我采样方法是否能解决已知的宫颈癌筛查障碍并随后提高筛查不足群体的参与率，证据有限。为填补这一研究空白，本研究旨在了解筛查不足群体在接受宫颈癌筛查过程中的经历和障碍；探讨符合筛查条件的个体对自我采样（阴道拭子采样和尿液采样）作为替代筛查方法的看法，以及这如何解决现有的筛查障碍。
我们借鉴三个综合理论框架（获得初级医疗服务、交叉性和女性主义视角）来研究参与者的筛查障碍以及对自我采样方法的看法。我们与志愿及社区社会企业部门合作，成功扩大了对服务不足社区的覆盖范围，对46名参与者进行了初步定性数据收集（访谈和焦点小组）。
筛查不足的参与者群体中，已知的宫颈癌筛查障碍依然存在，但我们也发现了许多良好实践的例子，即在整个筛查过程中，一些参与者的需求得到了满足。积极和消极的经历往往都围绕着与医护人员的互动，消极经历还集中在使用窥器方面。参与者对自我采样方法（阴道拭子采样和尿液采集）持积极态度，并且通过提供更多选择（在方法和地点上，这也与便利性相契合）可能会增强自主权，从而解决一些现有的障碍。去除窥器以及避免医护人员进行侵入性检查也受到了积极欢迎。
虽然筛查不足群体的宫颈癌筛查障碍仍然存在，但良好实践的例子很普遍。此类例子应更广泛地实施，以确保患者体验的一致性，并确保更好地满足筛查不足群体的需求。将自我采样与传统方法一起引入可能会减少筛查障碍，并可能提高筛查不足群体的筛查率，但前提是要提供适当的信息并进行充分的沟通。如果不考虑这些因素就实施自我采样，可能会破坏自我采样方法已确定的重要益处。
