Barriers to participation in cervical screening experienced by 25-29-year-olds can stem from various sources, including patient, healthcare provider, or health system factors. Women and individuals with a cervix may encounter diverse challenges that impact their decision or ability to attend screening appointments. These barriers vary across different groups or communities, influencing participation rates.

The barriers outlined below have been gathered from analysis of past campaigns, reviews of the cervical screening programme, and the work of advocacy organisations. While these barriers are specific to this age group, other groups may also encounter similar challenges that impact their decision or ability to attend screening appointments.

Patient-related barrier

Emotional and cultural barriers

Such as:

• embarrassment about the procedure
• fear of tests that could result in a diagnosis of cancer
• reluctance to screen after a negative experience such as previous pain or discomfort
• history of sexual abuse or sexual violence
• confidentiality concerns
• cultural issues (related to circumstances, beliefs, background, and inequities in society)

Barriers in knowledge

Lack of knowledge about:

• the purpose of cervical screening
• the role of screening in prevention
• the risks of cervical cancer
• who needs to be tested
• the accuracy of the test
• cancer or a belief that cancer equals death

Barriers related to perception of personal relevance

Such as:

• not believing cervical cancer is a risk
• not considering screening to be a priority
• limited previous experience of prevention or screening programmes
• being asymptomatic
• perception that HPV vaccinated people do not require screening
• perception that women who have sex with women, or transgender men, don’t require screening

Practical barriers

Such as:

• time constraints, including availability of childcare
• intending to have a test but not getting around to doing it, or forgetting when the test is due
• concerns about cost – travel, time off work
• language issues
• lack of transport
• physical, social, or practical barriers associated with a disability, mobility, or obesity
• lack of choice of clinician performing the screening

Healthcare system and provider-related barriers

Healthcare provider-related barriers

Such as:

• time constraints and pressure to restrict consultation times
• availability of female healthcare professionals trained to perform screening
• the patient not knowing the healthcare professional personally
• possible lack of interpersonal and communication skills to help put people at ease
• lack of trust in some ethnic minorities who may have experienced this screening by a specialist doctor e.g. a gynaecologist (in other countries’ healthcare systems) and may have concerns about it being delivered by a nurse

System-related barriers

Such as:

• accessibility of the surgery, including availability of ramps and hoists
• ease of making an appointment and availability of convenient appointment times
• services without (or perceived to be without) a culturally sensitive environment (for example, no access to translated resources or awareness of translation services)
• availability of female healthcare professionals or enough healthcare professionals who are trained as cervical screeners
• availability of translated patient information

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