A qualitative analysis of factors in cervical screening attendance decision-making

Background: Cervical cancer is largely preventable through human papillomavirus (HPV) vaccination and regular cervical screening, yet screening uptake in UK remains below the 80% target, at around 70%. While barriers such as fear and embarrassment are well-documented, less is known about how women interpret screening information through their personal beliefs and experiences. This study addresses the research question: “What matters to women when deciding whether or not to attend cervical screening?”

Methods: Qualitative semi-structured interviews with 44 women aged 18-45 living in the UK were conducted. The interview schedule was based on illness perceptions and health beliefs and included questions relating to awareness, attitudes and beliefs about cervical screening. Data were analysed using reflexive thematic analysis.

Findings: Three themes were generated: purpose of screening, screening experience, and knowledge. Women who saw screening as lifesaving were more motivated to attend than those who viewed it as test for cancer, indicating that the perceived purpose of screening plays a critical role in decision-making. Second, screening experiences – particularly pain or vulnerability – shaped future attendance more than general health-attitudes. Finally, women perceive a lack of knowledge about screening and the screening process, acting as barrier.

Discussion: The analysis identified complex relationships between screening-related knowledge, experiences and understanding, whereby understanding can encourage or deter screening uptake. Knowledge is not objective, but interpreted through personal values, beliefs and meaning. These findings suggest that to improve screening uptake, interventions must move beyond information-provision to focus on meaningful engagement that is tailored to address personal beliefs and values.