Developing and piloting an intervention to reduce colposcopy non-attendance and corresponding inequalities: a...

Area of Science:

• Public Health
• Gynecology
• Health Services Research

Background:

• Cervical cancer disproportionately affects lower-income populations, with higher non-attendance for colposcopy in deprived areas and among younger individuals.
• Diagnostic delays in cervical cancer screening can lead to undetected or late-treated pre-cancerous conditions, diminishing screening benefits.
• Understanding and addressing barriers to colposcopy attendance is crucial for improving screening program effectiveness and reducing health disparities.

Purpose of the Study:

• To investigate the primary drivers of non-attendance for colposcopy appointments.
• To develop and pilot a targeted intervention aimed at improving colposcopy appointment attendance.
• To assess the impact of the intervention on colposcopy non-attendance rates, particularly in vulnerable populations.

Main Methods:

• Qualitative data were collected through interviews with patients who attended, cancelled, or did not attend colposcopy appointments.
• Thematic analysis identified key barriers and enablers to attendance, informing the design of a pilot intervention.
• A pre-appointment telephone contact intervention was implemented to identify and address individual attendance barriers, with non-attendance rates compared pre- and post-intervention.

Main Results:

• Key attendance barriers included administrative issues, forgetting appointments, anxiety, work, childcare, and transport difficulties.
• The pilot intervention, involving pre-appointment telephone calls, successfully contacted 65% of scheduled patients.
• Overall non-attendance decreased from 10% pre-intervention to 8% during the intervention period. For patients aged 25-39 in the most deprived areas, non-attendance dropped from 20% to 12%.

Conclusions:

• A proactive telephone intervention effectively addresses barriers to colposcopy attendance, leading to reduced non-attendance rates.
• Targeted interventions show promise in improving cervical cancer screening effectiveness and mitigating health inequalities, especially for younger and more deprived populations.
• Further research is warranted to validate these findings in broader settings beyond the specific NHS trust studied.