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A mother booking a routine cervical or breast screening appointment on the phone with help from her daughter in the kitchen.
Health professionals

Last reviewed: 30 June 2025

Encouraging informed participation in cervical screening

The latest evidence on barriers to participation and resources to support your patients to make an informed choice.

Last reviewed: 30 June 2025

Understanding the barriers to screening participation

Understanding who is not attending screening and the barriers preventing them from participating is important when looking at ways to support engagement with the programme. The reasons for non-attendance may be complex and several factors may be at play. It is important to address these different barriers to enable everyone who’s eligible to attend screening if they want to. 

Barriers to screening participation:

Personal perception of screening 

  • Feeling embarrassed 

  • Worry that the procedure will be painful (especially for post-menopausal women) 

  • Concern for sexual connotations and being perceived as promiscuous 

  • Fear of what the test may find 

  • Lack of awareness of the purpose of screening  

  • Perceived low risk of cervical cancer (eg not currently sexually active or in a lesbian relationship) 

  • Religious beliefs (eg trust in God or outcomes being “God’s will”) 

Personal experience which impacts decision to attend 

  • Lack of trust with the health system 

  • Previous negative screening experience (eg past painful procedure) 

  • Previous sexual assault or abuse 

  • Negative body image issues 

  • Gender dysphoria 

Practical or access barriers such as: 

  • Difficulty arranging an appointment at a convenient time 

  • Intending to go but forgetting or not getting round to it 

  • Inaccessible information due to language or mode of delivery

Groups with lower participation:

  • people aged 25–29 and those above 50

     

  • people living in areas of high deprivation

  • people with a learning or physical disability

  • ethnic minority communities – note disparity varies by ethnic minority group

  • people who are lesbian or bisexual

  • the transgender community

  • people with severe mental illness

There may also be other groups in your practice population that face barriers to participating in screening. Use your practice data to identify people who are not attending screening to consider strategies to support their informed participation.  

Supporting people to access screening

Discuss cervical screening with your patients

Although cervical screening is a familiar procedure for primary care staff, for most people it is not a routine process. When you have the opportunity, talk about screening with your patients, making sure to discuss potential concerns and address barriers. 

Impersonal patient-provider relationships have been found to be a barrier to participation in some underscreened populations. Ensure your patients feel safe, supported and able to participate, through a good rapport and ensure people feel listened to during appointments

Send tailored reminders

People receive a letter when they’re invited for cervical screening. In England, people who use the NHS App will be notified digitally first. Encourage people to keep their contact details up to date so that invitations reach your patients. 

In addition to screening invitations, consider different options for reminding patients of their cervical screening appointment:  

  • A targeted text message, endorsed by the GP can increase uptake

  • A proactive telephone call 

  • Targeted letter to someone who is overdue or who has never attended an appointment. 

Consider how your target population would want to be communicated with and try to tailor communication methods to different groups. For example, younger people have been found to prefer digital information

Templates and top tips can be found in our cervical good practice guide(PDF, 1.57 MB).  

Primary care training and development 

Practice staff should undertake training to ensure they’re aware of potential barriers, support they can offer to address them and how to discuss this appropriately with people.

Share learning 

Check your local screening data to identify whether there are any particular areas requiring improvement. You can find out what other practices in your area may be doing in case there is an opportunity to work together, or to share good practice.  

To find out about system-wide recommendations which could improve screening coverage, check out our Future optimisation of cervical screening page. 

Case study

For full information, click to see case study 5

Invitations for trans men and non-binary people with a cervix

The call and recall systems used in cervical screening programmes invite people based on their gender as recorded in their primary healthcare record.  GP practices should manage cervical screening administration for eligible people with a cervix registered as male or “indeterminate” with their GP practice who want to opt into screening.   

In Scotland, anyone who is eligible for screening and has changed their gender in their primary healthcare record since June 2015 should receive automatic invitations to cervical screening. People who changed their gender in their primary healthcare record prior to June 2015 will not receive automatic invitations to screening.  

In England, trans men and eligible non-binary people can opt in to cervical screening via their GP practice, sexual health clinic or transgender services and receive invitations automatically.   

GP practices still have a key role in proactively identifying and opportunistically consulting people about whether they’d like to be invited to cervical screening.  

Safety netting

Let patients know when they should expect to receive their screening results, and who to contact if they do not receive their results in the expected timeframe.  

Patients and health professionals should be aware that a previous normal cervical screening test result does not rule out cancer. 

Remind your patients, regardless of whether they participate in screening, their HPV status or HPV vaccination status, that they should contact a health professional if they have any symptoms or changes that are not normal for them. You could share our public information on cervical cancer symptoms. 

Read more about safety netting on our webpage for healthcare professionals. 

Colposcopy attendance 

Primary care can support colposcopy attendance following primary cervical screening, by understanding patient barriers. Anxiety, work or childcare commitments, transport and forgetting the appointment have all been identified as barriers to colposcopy attendance. In addition, non-attendance is higher in more deprived areas and among younger people

.  

Consider how you can contact people invited for colposcopy with a text or phone call to encourage them to attend.  

Resources 

Read more about cervical screening

Illustration of a cervix.

Cervical

Get resources to support uptake, including information on safety netting and barriers to participation.

Illustration of a magnifying glass.

Cervical cancer prevention: HPV vaccination and screening

Read about primary human papillomavirus (HPV) testing and cervical screening coverage.

Illustration of a shield with tick symbol.

Future optimisation of cervical screening

Covers extending screening intervals, self-sampling and wider quality improvements.

References

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    Judah G, et al. A population survey on beliefs around cervical cancer screening: determining the barriers and facilitators associated with attendance. BMC Cancer. 2022  

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    Wilding, S., et al. What factors are most influential in increasing cervical cancer screening attendance? An online study of UK-based women. Health Psychology and Behavioral Medicine, 2020. 

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    Waller J, et al. Barriers to cervical cancer screening attendance in England: a population-based survey. J Med Screen. 2009 

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    Chorley, A. J., et al. Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis. Psycho-Oncology. 2017 

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    Wearn, A. & Shepherd, L. Determinants of routine cervical screening participation in underserved women: a qualitative systematic review. Psychology & Health, 39:2, 145-170, DOI: 10.1080/08870446.2022.2050230. 2024 

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    Douglas, E., et al. Socioeconomic inequalities in breast and cervical screening coverage in England: are we closing the gap? Journal of Medical Screening. 2016

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    Urwin, S. et al., Factors associated with cervical screening coverage: a longitudinal analysis of English general practices from 2013 to 2022, Journal of Public Health. 2023. 

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    Saunders CL, et al. Cervical screening attendance and cervical cancer risk among women who have sex with women. J Med Screen. 2021. 

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    Berner, A. M., et al. Attitudes of Trans Men and Non-binary People to UK Cervical Screening. British Journal of General Practice. 2021. 

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    Kerrison, R. S. et al., Inequalities in cancer screening participation between adults with and without severe mental illness: results from a cross-sectional analysis of primary care data on English Screening Programme. Nature. 2023. 

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    Huf S, et al. Behavioural text message reminders to improve participation in cervical screening: a randomized controlled trial. The Lancet. 2017. 

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    Charlton, C. & Rodrigues, A. M. How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour. Health Psychol. Behav. Med. 2024 

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    Douglas E, et al. Colposcopy attendance and deprivation: A retrospective analysis of 27,193 women in the NHS Cervical Screening Programme. Br J Cancer. 2015 


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