Tackling cervical cancer through targeted communication
Comprehensive screening programmes and early diagnoses are critical elements in the fight against cervical cancer, the fourth most common cancer affecting women worldwide. Screening programmes can be used for example to detect the human papillomavirus (HPV), the virus that causes cervical cancer. “Many European countries have implemented HPV vaccination and screening programmes,” notes CBIG-SCREEN(opens in new window) project coordinator Marc Bardou from the University of Burgundy(opens in new window) in France. “While these countries have seen a decline in cervical cancer deaths, we appear to have reached a plateau.” This, say experts like Bardou, is because certain vulnerable groups such as women in precarious socio-economic situations, or women living with HIV, are not being reached enough by these life-saving programmes – and these are groups that are most at risk. The EU-funded CBIG-SCREEN project, coordinated by the National Institute of Health and Medical Research(opens in new window) (Inserm) in France, sought to address this challenge.
Examining impact of vaccination programmes
To achieve its aims, the project brought together healthcare professionals, behavioural economists, social scientists and communication experts to develop more tailored and effective interventions. The project team wanted to better understand how at-risk groups could be encouraged to participate in screening programmes. “The idea was to develop communication programmes that not only reach everyone but are adapted to reach those that are hardest to reach,” explains Bardou. “We also wanted to convince policymakers of the importance and potential benefits of such approaches.” Academic research was combined with fieldwork. The project examined the organisation and impact of screening programmes from across Europe, but focused in particular on three European countries from different regions: Estonia, Portugal and Romania.
Better targeting vulnerable groups
“Several important findings came out of this work,” says Bardou. “For example, out of the 22 European countries that responded to our survey, only six demonstrated a proper understanding that certain groups of women are vulnerable to a higher risk of developing cervical cancer.” Furthermore, the project team found that even countries which claimed to have screening programmes tailored to vulnerable women actually did not have any. The project also identified several key factors preventing many women from being screened. These included a fear of being diagnosed, as well as embarrassment and shame related to contracting HPV. These were significant drivers of non-attendance and were reported across all European countries. In Portugal, one of the target countries, text messaging was trialled as a means of engaging, educating and encouraging vulnerable, economically disadvantaged women to participate in screening programmes. This was found to be unsuccessful. In Romania however, free HPV self-sampling was successfully taken up. However, the project found that many samples were not properly collected. “This showed that we need to be effective in communicating how to properly administer tests,” adds Bardou. “There was huge interest in self-sampling, but women need to be guided.”
Combined screening and vaccination
These findings will now be built upon in a follow-up EU project entitled HPV-FASTER-Implement. In the project, the team is looking to offer HPV screening and vaccination at the same time to vulnerable women aged between 25 and 45. Bardou and his team believe that by reducing the number of interactions required, underserved populations can be better protected. “We also learned from CBIG-SCREEN the importance of bringing policymakers on board,” says Bardou. “We also want to increase health literacy about cervical cancer prevention, not only among women but also among health professionals. We need everyone on board.”
