Advancing understanding of influences on cervical screening (non)‐participation among younger and older women: A qualitative study using the theoretical domains framework and the COM‐B model
Open accessAbstract
Background: Effective screening can prevent cervical cancer, but many women choose not to attend their screening tests. Objective: This study aimed to investigate behavioural influences on cervical screening participation using the Theoretical Domains Framework (TDF) and COM‐B models of behaviour change. Design: A qualitative study and semistructured phone interviews were conducted with women invited for routine screening tests within the national cervical screening programme in Ireland. Setting and Participants: Forty‐eight women aged 25–65 years were recruited from the national screening register. Results: Seven core themes were identified that mapped to three COM‐B components and 11 TDF domains: (1) knowledge of cervical cancer and screening, (2) coping with smear tests, (3) competing motivational processes—automatic and reflective, (4) cognitive resources, (5) role of social support, (6) environmental influences and (7) perceputal and practical influences. A range of knowledge about screening, perceived risk of cervical cancer and human papillomavirus infection was evident. Factors that influenced screening behaviours may be hierarchical—some were assigned greater importance than others. Positive screening behaviours were linked to autonomous motivation. Deficits in physical and psychological capability (inadequate coping skills) were barriers to screening, while physical and social opportunity (e.g. healthcare professional ‘champions’) could facilitate participation. Older women raised age‐related issues (e.g. screening no longer necessary) and had more negative attitudes to screening, while younger women identified practical barriers. Conclusions: This study provides insight into screening participation and will aid development of theoretically informed interventions to increase uptake. Patient or Public Contribution: Women invited for screening tests through the national screening programme were interviewed. A Public & Patient Involvement (PPI) Panel, established to provide input into all CERVIVA research projects, advised the research team on recruitment materials and were given the opportunity to review and comment on the interview topic guide. This panel is made up of six women with various cervical screening histories and experiences.
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First-time attendees and young women often face challenges in attending CC screening, such as difficulties making appointments, time constraints and perceived low priority.
“first-time attendees and young women often face challenges in attending CC screening, such as difficulties making appointments, time constraints and perceived low priority.13,14”
From Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review (2025) · cites this paper as [14]
The Results (Thematic results; page not provided) report that younger women faced time pressures and difficulty accessing appointments, and that many considered screening a low priority. The paper does not establish these barriers specifically for first-time attendees; its sampling included women with varied screening histories. (LLM, conf=0.87)
Experimental — accuracy not yet measuredLack of coping skills during the testing procedure was a barrier to CC screening in an Irish study.
“Also, lack of coping skills during the testing procedure (e.g., deep breathing) was a barrier to CC screening in an Irish study [16].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [16]
Autonomous motivation is associated with increased screening.
“For example, autonomous motivation [16], i.e., acting out of a sense of willingness as opposed to pressure [19], motivation to stay healthy and have peace of mind, and motivation due to someone close being affected by cancer [9] have been associated with increased screening.”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [16]
The overall quality of the 106 included studies was rated as medium based on the MMAT quality score.
“The overall quality of the 106 studies were rated as medium, based on the MMAT quality score.”
From Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review (2025) · cites this paper as [14]
The Results (Characteristics of the study participants; page unavailable) describe interviews with 48 women, and Methods (Coding and analysis; page unavailable) describe analysis of those interviews. A search of our copy for 106 included studies and MMAT quality assessment found no passage reporting a medium quality rating for 106 studies. (LLM, conf=0.76)
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References 35 · Cited by 42
Research works printed but not linked: 25
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- Authors
- O'Donovan, B., Mooney, T., Rimmer, B., Fitzpatrick, P., Flannelly, G., Doherty, L., Martin, C., O'Leary, J., O'Connor, M., & Sharp, L.
- Affiliations
- Royal College of Surgeons in Ireland (RCSI) Dublin Ireland
- Programme Evaluation Unit, National Screening Service Dublin Ireland
- Newcastle University (GB)
- University College Dublin (IE)
- National Maternity Hospital (IE)
- National Screening Service Dublin Ireland
- Trinity College Dublin (IE)
- Department of Histopathology Trinity College, University of Dublin Dublin Ireland
- School of Public Health University College Cork Cork Ireland
- Corresponding author
- Sharp, Linda
- Venue
- Health Expectations
- Publisher
- Wiley
- Published
- 2021-09-02
- Volume
- 24
- Issue
- 6
- Pages
- 2023-2035
- ISSN
- 1369-6513 (ISSN-L)
- 1369-7625
- PMC
- PMC8628586
- OpenAlex
- W3197802183
- Cited by
- 42
- References
- 35
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 16 · 2023: 2 · 2022: 3 · 2021: 2
- FWCI
- 4.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Health Expectations (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Funders
- Health Research Board
- Royal College of Surgeons in Ireland
- Irish Research eLibrary
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- cervical cancer screening, screening uptake, Theoretical Domains Framework, COM-B model, behavior change, older women, young women, autonomous motivation, social support, risk perception, human papillomavirus, barriers to screening, cervical cancer prevention
- MeSH terms
- Aged, Uterine Cervical Neoplasms, Female, Humans, Mass Screening, Motivation, Qualitative Research, Early Detection of Cancer
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