Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review

Background:

Cervical cancer (CC) results in around 604,00 new cancer cases yearly and is caused by the human papillomavirus (HPV). Uptake rates for both the HPV vaccination and screening have been decreasing over recent years, particularly in young women, whilst CC remains a concern for both low- and high-income countries.

Objectives:

To highlight the key barriers and facilitators of CC screening attendance in young women and to identify the factors associated with their CC screening behaviour, to inform interventions to increase screening rates.

Design:

Systematic review.

Data sources and methods:

A systematic review was conducted using Scopus, Web of Science, MEDLINE, PsycINFO/PyscARTICLES and CINAHL. The review included primary qualitative, quantitative and mixed-method studies that reported barriers, facilitators and factors associated with current CC screening behaviours in women aged 30 or below. Outcomes were summarised narratively. Risk of bias was conducted for individual studies using the Mixed-Method Appraisal Tool.

Results:

Among the 106 studies included in the review, the most frequently reported barriers were financial constraints (n = 36), embarrassment (n = 35) and low accessibility to obtaining screening (n = 34). The most frequently reported facilitators were knowledge of CC (n = 12), healthcare provider recommendations (n = 11) and communication with friends (n = 11). Age (older), marital status (in a relationship) and sexual activity (active) were key factors associated with attendance at screening. Studies also highlighted that those vaccinated were more likely to have screened than those not vaccinated against HPV.

Conclusion:

These unique factors represent potential targets for interventions to increase CC screening attendance in young women. Future research could benefit from employing strong theoretical frameworks, such as the COM-B model of behavioural change, to categorise and gain further insight into the contributing factors affecting CC screening attendance.

Registration:

PROSPERO CRD42022324948.