Periodic Reporting for period 2 - CBIG-SCREEN (Working collaboratively with vulnerable women to identify the best implementation gains by screening cervical cancer more effectively in European countries)
Reporting period: 2022-09-01 to 2024-02-29
Cervical cancer (CC) is the second most common cancer in women under 45 years. In Europe almost 26,000 women will die of it each year – each death being a tragedy considering that CC is a preventable disease. The relatively high death rate has been largely attributed to low vaccination coverage and low cervical cancer screening rates among vulnerable women. Though screening programmes drastically reduce cervical cancer mortality, they remain largely inaccessible and underused by subpopulations of vulnerable women, creating inequality in the European healthcare system and adding to the challenges underserved populations already face in their efforts to maintain their socioeconomic and physical health.
Healthcare inequality is at the heart of CBIG-SCREEN’s effort to provide vulnerable subpopulations with functioning access to cervical cancers screening, improve health outcomes and reduce associated costs. The CBIG-SCREEN focusses on women: of low socioeconomic status, living with HIV, incarcerated, sex workers or migrants, among other groups. The consortium will work in collaboration with these women to develop strategies to meet their specific needs, to attract them to the screening programmes, and to retain them from initial test to treatment. Through continuous dialogue we aim to convince policymakers to adopt these strategies ensuring that national screening programmes reach out to promote these interventions to communities of the underserved women.
CBIG-SCREEN will create a Europe-wide knowledge framework around barriers to cervical cancer screening and generate policies, programmes, communications and other required services to meet the needs of these underserved sub-populations of women with inherent high-risk of cervical cancer and low (perceived) access to proper healthcare routes. Our interventions aim to reduce health inequality by increasing screening ratios among vulnerable women from 26% to 45% which could ensure up to 6,000 to 7,000 more women will survive each year.
Healthcare inequality is at the heart of CBIG-SCREEN’s effort to provide vulnerable subpopulations with functioning access to cervical cancers screening, improve health outcomes and reduce associated costs. The CBIG-SCREEN focusses on women: of low socioeconomic status, living with HIV, incarcerated, sex workers or migrants, among other groups. The consortium will work in collaboration with these women to develop strategies to meet their specific needs, to attract them to the screening programmes, and to retain them from initial test to treatment. Through continuous dialogue we aim to convince policymakers to adopt these strategies ensuring that national screening programmes reach out to promote these interventions to communities of the underserved women.
CBIG-SCREEN will create a Europe-wide knowledge framework around barriers to cervical cancer screening and generate policies, programmes, communications and other required services to meet the needs of these underserved sub-populations of women with inherent high-risk of cervical cancer and low (perceived) access to proper healthcare routes. Our interventions aim to reduce health inequality by increasing screening ratios among vulnerable women from 26% to 45% which could ensure up to 6,000 to 7,000 more women will survive each year.
WP1 – WP1 ensures that the project meets its objectives. Coordination has continued to closely monitor the progress organising 2 annual and three-monthly Executive Commitee meetings and an interim progress meeting involving all partners after 30 months.
WP2 - WP2 aims at mapping existing Cervical cancer screening (CCS) policies and in particular those trying to broaden the coverage of CCS among vulnerable women (VW), mapping stakeholders who could affect or be affected by new interventions and identifying their perspectives on barriers and solutions. The online survey we developed to all EU countries showed that only few have policies dedicated to increase CCS participation among VW. We made an interactive map of whom to contact, and we facilitated Collaborative User Boards (CUBs, advisory boards with VW, healthcare professionals, and decision-makers) in seven partner countries to discuss and identify barriers and solutions to CCS. More than 95 stakeholders have participated in these CUBs to tailor the interventions to be developed and piloted in the project. The first paper about results from the CUBs has been accepted for publication in BMJ Open.
WP3 - WP3 aims to improve CCS access for vulnerable women using measures that are evidence-informed, acceptable, and feasible. CUBs identified VW, healthcare professionals and policy makers to involve in co-creating tailored interventions to improve CCS access. We adapted and extended a conceptual model of population-based CCS, developed within the Horizon 2020 EU-TOPIA project, to identify barriers experienced by VW. The literature review on barriers and facilitators to participating in CCS amongst VW groups in Europe has been completed.
WP4 - WP4 aims at informing the design of efficient CC prevention policies by understanding the preferences of VW for different interventions, and identifying possible societal issues related with the implementation of targeted interventions. The literature review on the normative foundations of targeted interventions in women healthcare use is ongoing and the qualitative work interviews in France, Romania, and Bulgaria have been completed and synthesized in a report. Early results of the Discrete Choice Experiment on VW’s preferences are available for France and Estonia. Results from Romania and Portugal will follow.
WP5 - WP5 aims to assess the cost effectiveness of CCS strategies tailored to increase participation of VW. We have systematically reviewed economic evaluations of increased screening in VW in Europe and found little evidence. We have conceptualized our modelling approach and commenced configuring it for the different settings .
WP6 - WP6 aims to support the co-creation of tailored strategies to increase CCS matching the needs of VW in Estonia, Portugal, and Romania, implement these strategies and evaluate their effectiveness. After assessing the capacity of CCS related services, we developed the protocol and data collection tools for phase I. Phase I is ongoing in Portugal and finished in Estonia and Romania. The protocol for phase II is finalized for Estonia and under discussion for Romania and Portugal.
WP7 - As the project develops and work is carried out, WP7 has continued the ongoing work of social media updates and information dissemination, as well as expanded our social media profile to include YouTube and Instagram. A roundtable in the European Parliament was hosted by CBIG-SCREEN, the first newsletter was published, and plans to join up with other H2020 projects for the second roundtable in the European Parliament were made. The CBIG-SCREEN publication guidelines were expanded, and several scientific articles were submitted and/or accepted for publication.
WP2 - WP2 aims at mapping existing Cervical cancer screening (CCS) policies and in particular those trying to broaden the coverage of CCS among vulnerable women (VW), mapping stakeholders who could affect or be affected by new interventions and identifying their perspectives on barriers and solutions. The online survey we developed to all EU countries showed that only few have policies dedicated to increase CCS participation among VW. We made an interactive map of whom to contact, and we facilitated Collaborative User Boards (CUBs, advisory boards with VW, healthcare professionals, and decision-makers) in seven partner countries to discuss and identify barriers and solutions to CCS. More than 95 stakeholders have participated in these CUBs to tailor the interventions to be developed and piloted in the project. The first paper about results from the CUBs has been accepted for publication in BMJ Open.
WP3 - WP3 aims to improve CCS access for vulnerable women using measures that are evidence-informed, acceptable, and feasible. CUBs identified VW, healthcare professionals and policy makers to involve in co-creating tailored interventions to improve CCS access. We adapted and extended a conceptual model of population-based CCS, developed within the Horizon 2020 EU-TOPIA project, to identify barriers experienced by VW. The literature review on barriers and facilitators to participating in CCS amongst VW groups in Europe has been completed.
WP4 - WP4 aims at informing the design of efficient CC prevention policies by understanding the preferences of VW for different interventions, and identifying possible societal issues related with the implementation of targeted interventions. The literature review on the normative foundations of targeted interventions in women healthcare use is ongoing and the qualitative work interviews in France, Romania, and Bulgaria have been completed and synthesized in a report. Early results of the Discrete Choice Experiment on VW’s preferences are available for France and Estonia. Results from Romania and Portugal will follow.
WP5 - WP5 aims to assess the cost effectiveness of CCS strategies tailored to increase participation of VW. We have systematically reviewed economic evaluations of increased screening in VW in Europe and found little evidence. We have conceptualized our modelling approach and commenced configuring it for the different settings .
WP6 - WP6 aims to support the co-creation of tailored strategies to increase CCS matching the needs of VW in Estonia, Portugal, and Romania, implement these strategies and evaluate their effectiveness. After assessing the capacity of CCS related services, we developed the protocol and data collection tools for phase I. Phase I is ongoing in Portugal and finished in Estonia and Romania. The protocol for phase II is finalized for Estonia and under discussion for Romania and Portugal.
WP7 - As the project develops and work is carried out, WP7 has continued the ongoing work of social media updates and information dissemination, as well as expanded our social media profile to include YouTube and Instagram. A roundtable in the European Parliament was hosted by CBIG-SCREEN, the first newsletter was published, and plans to join up with other H2020 projects for the second roundtable in the European Parliament were made. The CBIG-SCREEN publication guidelines were expanded, and several scientific articles were submitted and/or accepted for publication.
Advancing the perspectives on barriers and solutions from stakeholders including VW will help to select the most appropriate interventions to increase CCS coverage, and tailor the interventions to specific contexts for a successful implementation.
Collaborating with people who are most affected, CBIG-SCREEN is moving towards identifying the barriers that disproportionately impact VW and how can we improve CCS within but also outside of traditional healthcare settings. By engaging a range of stakeholders in this way, we can better understand the ingredients to an accessible pathway to CCS.
We will contribute to understand the actual impact of targeted CC prevention policies in a real-life context, as the effectiveness of interventions depends on the context and other determinants hardly captured by quantitative approach. This will inform WP3 in providing precise and realistic estimates of the cost-efficiency of targeted CC prevention policies.
Our systematic review shows that little is known about the cost-effectiveness of increasing screening participation for specific vulnerable groups.
The protocol and tools developed to assess the capacity of CCS related services can be used by the health system in other countries before introducing interventions to increase CCS among VW.
Finally, communicating the progress of the project has to date reached a large audience, highlighting the importance in targeting vulnerable and hard to reach groups in the uptake of CCS. The project has targeted policy makers, health professionals and women themselves with the aim to mitigate against the barriers in uptake by VW.
Collaborating with people who are most affected, CBIG-SCREEN is moving towards identifying the barriers that disproportionately impact VW and how can we improve CCS within but also outside of traditional healthcare settings. By engaging a range of stakeholders in this way, we can better understand the ingredients to an accessible pathway to CCS.
We will contribute to understand the actual impact of targeted CC prevention policies in a real-life context, as the effectiveness of interventions depends on the context and other determinants hardly captured by quantitative approach. This will inform WP3 in providing precise and realistic estimates of the cost-efficiency of targeted CC prevention policies.
Our systematic review shows that little is known about the cost-effectiveness of increasing screening participation for specific vulnerable groups.
The protocol and tools developed to assess the capacity of CCS related services can be used by the health system in other countries before introducing interventions to increase CCS among VW.
Finally, communicating the progress of the project has to date reached a large audience, highlighting the importance in targeting vulnerable and hard to reach groups in the uptake of CCS. The project has targeted policy makers, health professionals and women themselves with the aim to mitigate against the barriers in uptake by VW.