Barriers to cervical screening and diagnosis in Northern Ireland

  • Sarah Faisal K Alawi

Student thesis: Doctoral ThesisDoctor of Philosophy


Cervical cancer is the fourth most frequent malignancy affecting women. Since 2007, the number of women attending cervical screening has decreased annually in the United Kingdom (UK), prompting Public Health England to devise a strategy for increasing uptake. The majority of women who miss their cervical screening are aged 25-29 years, the first group in whom such screening is offered to women without a family history, and those over 50 years. This dissertation aimed to establish evidence on barriers to the uptake of cervical screening, knowledge and attitudes of young Northern Ireland (NI) women with regard to human papillomavirus (HPV), cervical cancer and their cervical screening intent, and the epidemiology of CIN3 precancerous lesions in NI. Initially, a systematic literature review was conducted with the aim of investigating barriers to the uptake of cervical screening, yielding a total of 2l systematic reviews. Considerable variation in the identified barriers to cervical cancer screening between and within countries, socioeconomic groups, urban and rural populations, and age-groups were identified. The results of an online survey of women in NI aged IS to 24 years old, aiming to explore knowledge and attitudes around HPV and cervical cancer and to assess the intent to attend cervical screening, show that knowledge about and awareness of HPV, the HPV vaccine, cervical cancer and cervical cancer screening are limited. In terms of first-time cervical screening intentions, results of the survey indicate that over 80% of respondents would most likely go for a cervical screening. A third study assessing the epidemiology ofCIN3 precancerous lesions identified 862 women in NI in 2019 who had a CIN3 diagnosis. The majority of women diagnosed with CIN3 were less than 54 years old, Recommendations based on these research findings can be translated on to three areas, i.e. NI, the UK and Saudi Arabia. Policymakers and national health commissioners need to raise awareness and improve access to screening facilities amongst eligible women. This could be done by providing educational materials along with interventions such as social media campaigns, text reminders, or self- screening. Service providers and clinicians, both male and female, should ensure that they are at ease communicating with patients about smears, as well as having the abilities and skills to handle ‘difficult” smear- related encounters, which can also help boost screening uptake. All those in the profession should be educated and trained so that women who have a male general practitioner are not disadvantaged. Young women in their early 20s and their parents can be particularly targeted to attend cervical screening by encouraging participation through social media and other media campaigns, as well as dedicated online resources with information provided.

Thesis embargoed until 31 July 2024.
Date of AwardJul 2022
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SponsorsMinistry of Health, Kuwait
SupervisorLesley Anderson (Supervisor), Finian Bannon (Supervisor) & Lynne Lohfeld (Supervisor)


  • HPV
  • cervical cancer
  • screening
  • human papillomavirus
  • screening barriers

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