The role of non-medical providers in increasing access to cervical screening: a scoping review

Involving non-medical providers (NMPs) in cervical screening interventions could be a promising strategy to increase cervical screening participation among never or underscreened populations. We undertook a scoping review of published literature to explore the potential role of NMPs in increasing cervical screening participation.

We searched three databases (MEDLINE, EMBASE and CINAHL) to identify relevant scientific research articles published between 2016 and 2024 and extracted data using a standardised extraction tool.

Our review identified 35 studies (randomised controlled trials (RCTs): n=12, non-RCTs: n=23) from a breadth of geographical and country-level income settings including Australia and New Zealand (n=3), Africa (n=7), Asia (n=4), Europe (n=3) and North (n=15) and South (n=3) America. NMPs in the included studies were community health workers, nurses and midwives; and their key roles involved identifying and recruiting target populations, delivering health education and raising awareness of cervical screening, facilitating self-sampling and providing navigation and follow-up assistance. Most studies included screening participants aged ≥30 years, who were underscreened, not pregnant, from ethnic minority populations, and living in rural or remote communities. NMP-facilitated cervical screening interventions were largely feasible and acceptable among target populations. Compared with the standard of care, which did not involve NMPs, NMP-facilitated interventions generally demonstrated an increased uptake of cervical screening in RCTs (n=11 out of 12) with relative increases ranging from 1.11 to 42.73. In four RCTs, where NMPs facilitated self-sampling, cervical screening uptake rates ranged from 32.0% to 81.0%. Most non-RCTs (n=18) involved NMPs in facilitating self-sampling, with screening uptake rates ranging from 9.0% to 100.0%. Key strategies identified were capacity-building of NMPs through training, and employing outreach strategies to reach underscreened women.

NMPs could play a wider and an important role in cervical screening, particularly in the context of self-sampling and have the potential to increase access and equity in cervical screening.