Cervical screenings in Govanhill are low among certain groups of women; we explored why this is the case and what is being done to increase the uptake of cervical screenings in the community.
Earlier this year, The Ferret revealed that in 2020-21 in Scotland, 440,000 people eligible for cervical screening had not had a smear test in the last three to five years. If compared to the average percentage of smear tests that show a positive result for Human Papillomavirus (HPV), some 37,000 of these 440,000 untested people could have the virus – and statistically, 340 of these may be potentially cancerous.
The reason that people don’t attend screenings when requested are many. Last autumn, Trudy went to her usual GP practice twice, two weeks apart, and the practice nurse was unable to take the sample with the tools she had at her disposal.
“It caused me a lot of pain and drew blood each time. I’ve instead been referred to a specialist service instead and am waiting on an appointment. Apparently, the nurse has to refer a handful of women to the hospital or sexual health clinic each month, as it’s not super unusual for them not to fit the speculums available at GP practices. It was a horrible experience, and I’d been putting it off for a number of years. I’m 29 now and hadn’t gone for my smear before because I was too nervous, and then the pandemic gave me a very good excuse to put it off for longer.”
“It was a horrible experience, and I’d been putting it off for a number of years. I’m 29 now and hadn’t gone for my smear before because I was too nervous, and then the pandemic gave me a very good excuse to put it off for longer.”
In the Sandyford sexual health clinic, a specialist service called My Body Back offers cervical screening and other services like contraceptive care, STI testing and maternity care specifically for people who’ve experienced sexual violence. Designed by survivors, alongside psychologists and healthcare providers, it’s based out of the Sandyford Clinic. Appointments last a full hour, with one-on-one time with specially trained female psychologists to talk about concerns and try some grounding techniques before the test begins.
But cultural factors can also contribute to reticence to attend tests. Cervical screening uptake has been shown to be lower in particular ethnic or community groups. In 2020, research into the Roma population in Sheffield found that the cervical screening uptake was between 40-53 per cent, well below the citywide average of 73.5 per cent. It was found that a longstanding distrust of the state’s new role in health underpinned many reasons for not attending.
Recognising these barriers, charity Jo’s Cervical Cancer Trust worked with the South Sector Health Improvement Team of the Health and Social Care Partnership in Glasgow to develop several interventions targeting groups in Govanhill, where screening rates are low.
In 2018, the uptake of smear tests at Practice A, located in Govanhill Health Centre, was approximately 69 per cent. So, a drop-in clinic was planned, particularly targeting those overdue for a screening. Farhat Khan, a health improvement practitioner in the South Locality Health Improvement Team, worked on the project in collaboration with the doctor’s surgeries based in the Govanhill Health Centre.
She said: “My colleague (speaking Slovakian) and I (speaking Urdu) made phone calls to invite people along. The reasons we heard for why people hadn’t come before were barriers like fear, embarrassment, lack of English language skills, bad experiences in the passband, a lack of priority.”
“My colleague (speaking Slovakian) and I (speaking Urdu) made phone calls to invite people along. The reasons we heard for why people hadn’t come before were barriers like fear, embarrassment, lack of English language skills, bad experiences in the passband, a lack of priority.”
On the day, a curtained-off stand was set up in the waiting room. Staff wore pink, gave out goofy bags, and their place was decorated with bunting and balloons. Around 20 women either attended the clinic or booked subsequent appointments because of the intervention from range of ethnically diverse backgrounds. A video that explains what happens with the test was also created in community languages, including Romanes (historically unwritten) language spoken by the Roma community.
This improved uptake has raised awareness for the patients at this practice and increased knowledge among non-clinical staff about the barriers some women face. This model has been repeated at other practices. Having interpreters and bi-lingual healthcare workers made a big difference, along with using a range of different communication methods. However, not enough time was made available, and not everyone showed interest was able to be seen at that time.
Recognising the particular barriers that Roma women may face, a member of the public engagement team at Jo’s Cervical Cancer Trust worked alongside a group of Romanian Roma women at Govanhill community centre, The Space. NHS Health Improvement staff trained two translators as peer educators, with a focus on group work, facilitator skills and cervical cancer awareness training.
These interventions were trialled pre-pandemic, and when Covid-19 hit, this put a pause on many programmes and projects. Even now, GP services have different priorities, meaning some health improvement team has recently secured funding to hold another event at The Space.
Farhat explained that this kind of laser focussed targeted approach had been applied to other areas, too: “For example, we know that bowel screening has particularly low uptake with South Asian men, so my colleague has been out speaking to men’s groups, as well as visiting the Glasgow Central Mosque and the Glasgow Gurdwara. We’ve also used this opportunity to promote cervical and breast screening awareness.”
The health improvement team aren’t involved in clinical delivery but instead works to: “improve the health and wellbeing of individuals or communities through enabling and encouraging healthy choices as well as addressing underlying determinants of health such as poverty and lack of educational opportunities.”
For Farhat, the community approach to projects like these is key: “I work with the community and just tell people about the benefits versus the risks so that people can make an informed choice about whether to participate in the screening programmes… Our connections with local community organisations are key to our work because if you don’t have that, you don’t get to hear the issues.”
Mind the Health Gap is a year-long collaboration between Greater Govanhill and The Ferret exploring the solutions to health inequalities. This project was funded by the European Journalism Centre through the Solutions Journalism Accelerator. This fund is supported by the Bill & Melinda Gates Foundation. Read more here.
