Barriers and facilitators to cervical cancer screening in the Eastern Mediterranean Region: a systematic review

Cervical cancer is the sixth most common cancer among women in Eastern Mediterranean Region. Although screening is recommended as the early detection policy to enable timely intervention, women across the region face diverse factors that either facilitate or hinder their participation in screening programmes. We aimed to systematically identify facilitators and barriers to cervical cancer screening (CCS) uptake among women in EMR countries.

This systematic review was conducted in 2024 (Prospero code = CRD42023443818). Literature search was performed using the PICO framework through Web of Sciences, Scopus, Science Direct, Embase and WHO Index Medicus for the Eastern Mediterranean Region (IMEMR) databases. PRISMA algorithm was followed for literature screening independently by two researchers. Extracted data were categorised based on Andersen and Newman Framework of Health Services Utilization.

Out of 234 studies identified, 66 met the inclusion criteria. Iran and Jordan contributed the highest number of included articles. Predisposing factors at the individual and health system-related were categorised into demographics, social structure and beliefs. Enabling individual items were classified at personal/family and community levels, whereas health system-related factors were grouped into health policy, financing and organizational domains. Need factors were designated solely as individual determinants and accordingly grouped into perceived and evaluated CCS facilitators or barriers.

Cervical cancer screening uptake in EMR countries is influenced by a complex interplay of individual, social, and health system-related factors. These were categorised into predisposing, enabling and need-based determinants require multi-level strategies to be addressed. Despite the existing supportive regional policies, persistent barriers such as lack of awareness, stigma, financial constraints, and limited access to services continue to pose significant challenges. These findings offer a foundation for future policy adaptation and programme development in countries of the EMR.