Understanding and addressing socioeconomic inequalities in routine cervical screening participation: development of an intervention strategy using the behaviour change wheel

Wearn, Angela (2020) Understanding and addressing socioeconomic inequalities in routine cervical screening participation: development of an intervention strategy using the behaviour change wheel. Doctoral thesis, Northumbria University.

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Abstract

From 1988, the National Health Service have offered all women, aged in between 25-64, routine cervical screening to detect precancerous abnormalities within the cervix. This screening programme is estimated to prevent around 5,000 cases of cervical cancer each year. Past research has highlighted socioeconomic inequalities in participation, whereby those living in the most deprived areas are least likely to attend in line with guidelines. However, the reasons behind these inequalities are not clear and existing interventions to increase uptake do not adequately take the socioeconomic context into account. As such, this thesis aimed to a) understand factors influencing participation for those living in areas of high relative deprivation and b) develop tailored intervention strategies to facilitate timely attendance within this group.

Following guidance from the Medical Research Council on developing complex interventions, a multimethod, qualitative programme of research was conducted to highlight the perspectives of women living in areas of high relative deprivation. A systematic review (Study1), one-on-one interviews (Study 2) and a qualitative online survey (Study 3) were conducted to provide in-depth insight into key factors influencing participation. Focus groups (Study 4a) with service users and interviews with health-related professionals (Study 4b) were then conducted to consider how these factors contribute to the observed socioeconomic inequalities in participation and consider ways in which any barriers might be best addressed. Findings across studies were then systematically combined with behavioural theory (Study 5) to develop an understanding of what needs to change for the target behaviour to occur and identify appropriate intervention components and strategies.

Findings suggested that cervical screening participation is determined by a complex accumulation of interrelating, multi-level factors. Application of the Theoretical Domains Framework suggested that Social Influence, Environmental context and resources and Emotion were the top three areas of influence most often mentioned by participants. Application of the COM-B model suggested that, to encourage timely attendance, changes were needed at in terms of women’s capability, opportunity and motivation to screen. Using guidance from the Behaviour Change Wheel and the Behaviour Change Taxonomy v1, these findings were then linked with intervention options and components likely to influence change within the target population and several intervention strategies were recommended.

This research is the first to use the Behaviour Change Wheel to systematically combine behavioural theory and the perspectives of the community in understanding and addressing socioeconomic inequalities in routine cervical screening participation. These findings can be used to further test and develop a range of novel interventions, and/or refine existing interventions, which aim to increase cervical screening attendance within areas of high relative deprivation.

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