Applying the COM-B model of behaviour change to cervical screening attendance in young women.

Cervical cancer, which is caused by the human papillomavirus (HPV), results in around 3,000 new cancer cases yearly in the UK. Cervical cancer rates in the UK have increased in young women over the last decade, and screening attendance has fallen to a 10-year low. As the majority of women and people with a cervix now reaching the screening age (24.5 years old) will be HPV vaccinated, research is needed to assess the impact of this successful immunisation programme on screening behaviours and further our understanding of the current barriers and facilitators to screening for both attendees and non-attendees.
In a systematic review of 106 studies looking at barriers, facilitators and factors associated with cervical screening in young women, it was found that there was an overall lack of application of theoretical models in cervical screening research. Therefore, I applied the COM-B model to a two-stage reflexive thematic analysis in a qualitative study of semi-structured interviews. This provided a more in-depth insight into the current barriers and facilitators to cervical screening. Further, a cross-sectional study found reflective motivations to be the only significant predictor of cervical screening. Using this evidence, an infographic was designed targeting motivational factors. The intention or motivation to attend cervical screening did not significantly improve. It is possible that the intervention infographic was not effective due to ceiling effects. There was some evidence to suggest that the infographic would be useful for those with neutral or negative baseline intentions to attend cervical screening.
Overall, the work in this PhD suggests that targeting reflective motivations is key to improving cervical screening attendance in young women and people with a cervix, particularly those with lower initial intentions, and that leveraging the positive impact of HPV immunisation through education can further increase uptake.