What influences Roma women attending NHS cervical screening? Knowledge, fear, and passive consent

Recent immigration from Eastern Europe poses new challenges in engaging with women eligible to have smears. The Roma population have low socioeconomic status, low educational status, and a life expectancy 10 years lower than other EU citizens. An audit of smear uptake in four 'Deep End' Sheffield practices identified as having >1000 registered Roma Slovak patients, demonstrated smear uptakes between 53% to 40%, all of which are below the Sheffield CCG average of 73.5%.

To establish the barriers, facilitators and attitudes of Roma women towards accessing the NHS cervical screening.

Semi-structured interviews were recorded, transcribed, and analysed thematically using an iterative, with independent verification of emergent themes. Interviews continued to data saturation. Interviews were carried out in the patient's home or a community centre, facilitated by a trained interpreter.

Sixteen women who self-identified as Roma, were interviewed. The overarching themes of 'language discordance', 'poor educational attainment', and 'passivity in receiving care', influenced the women's likelihood of smear uptake or the need for screening. These emergent themes underpinned a longstanding distrust of the role of the state in relation to the health needs of the community.

It is vital that we develop and evaluate appropriate interventions to increase smear uptake in migrant and other vulnerable populations. There is a need for the UK to adapt screening programmes to maximise uptake within 'hard to reach' groups, such as the 'Roma', who are likely to be at the highest risk of cancer and late presentation of the disease.