What factors influence access by new migrant and BME women to NHS cervical screening? Has the screening programme been adapted to improve uptake for these groups of women? A systematic narrative metasynthesis.

Problem

The ‘Roma’ constitute one of the largest minorities in Europe (est. 5-10 million), historically marginalized, with low educational status and high levels of deprivation. These factors contributed to recent mass ‘Roma’ migration to the UK (est.197,000 in 2013). Those practices with the highest deprivation scores have significantly lower smear uptake rates and it is these areas of deprivation were new migrants will often settle. Increased cervical cancer risk factors amongst Roma women include: smoking, obesity, early age first sexual intercourse, multiparity, multiple partners. Migrant Roma teenage women may miss the HPV vaccination programme, both in the UK and in Slovakia. There is a need to develop innovative approaches to engaging high-risk communities and individuals in NHS screening, especially those who are likely to be at the highest risk of cancer and late presentation of the disease and are often unable to access written information.

Approach

Systematic literature search, critical appraisal of identified publications relating to smear uptake in black and minority ethnic women and narrative meta-synthesis using standard systematic review methodology. Identification of 4 practices using citywide Roma population prevalance estimates to generate a purposive sample of Roma Slovak women (age, parity, smear status) for interview, facilitated by a Roma Slovak link worker. Interviews ongoing to data saturation (25-30 particpants). Interviews will be transcribed verbatim, data organised (NVivo software) and thematically analysed (self conscious) with independent verification.

Findings

Extraction of ethnicity data is complex. There is no universally accepted way to code Roma ethnicity. Some practices code ethnicity according to spoken language; in other practices, data were extracted based on Roma Slovak surnames. A systematic literature review with narrative meta-synthesis and preliminary analysis of qualitative data will be presented

Consequences

Cancers diagnosed through screening are more likely to be early stage cancers, compared with other referrals. The report ‘Achieving World-Class Cancer Outcomes: the Strategy for the NHS 2015-2020’ urges the development of innovative approaches to engaging high risk communities and individuals proactively in NHS screening. Through qualitative identification of barriers and facilitators to accessing the cervical screening programme, we plan to identify the components of a complex primary care based intervention to optimize smear uptake in the target BME population (Roma), using the MRC framework for the development of complex interventions.