Implementation of Australia's primary human papillomavirus (HPV) cervical screening program: The STakeholders Opinions of Renewal Implementation and Experiences Study

Julia M L Brotherton; Tracey McDermott; Megan A Smith; Dorothy A Machalek; Hannah Shilling; Khic-Houy Prang; Chloe Jennett; Claire Nightingale; Claire Zammit; Amy Pagotto; Nicole M Rankin; Margaret Kelaher

doi:10.1016/j.pmedr.2023.102213

Implementation of Australia's primary human papillomavirus (HPV) cervical screening program: The STakeholders Opinions of Renewal Implementation and Experiences Study

Prev Med Rep. 2023 Apr 20:33:102213. doi: 10.1016/j.pmedr.2023.102213. eCollection 2023 Jun.

Authors

Affiliations

¹ Formerly Employed at the Australian Centre for the Prevention of Cervical Cancer, Victoria, Australia.
² Evaluation and Implementation Science Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
³ The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, New South Wales, Australia.
⁴ Centre for Women's Infectious Diseases, Royal Women's Hospital Melbourne, Victoria, Australia.
⁵ Kirby Institute, University of NSW, New South Wales, Australia.

Abstract

In this study, we aimed to document stakeholders' experiences of implementing Australia's renewed National Cervical Screening Program. In December 2017, the program changed from 2nd yearly cytology for 20-69 year olds to 5 yearly human papillomavirus (HPV) screening for women 25-74 years. We undertook semi-structured interviews with key stakeholders including government, program administrators, register staff, clinicians and health care workers, non-government organisations, professional bodies, and pathology laboratories from across Australia between Nov 2018 - Aug 2019. Response rate to emailed invitations was 49/85 (58%). We used Proctor et al's (2011) implementation outcomes framework to guide our questions and thematic analysis. We found that stakeholders were evenly divided over whether implementation was successful. There was strong support for change, but concern over aspects of the implementation. There was some frustration related to the delayed start, timeliness of communication and education, shortcomings in change management, lack of inclusion of Aboriginal and Torres Strait Islander people in planning and implementation, failure to make self-collection widely available, and delays in the National Cancer Screening Register. Barriers centred around a perceived failure to appreciate the enormity of the change and register build, and consequent failure to resource, project manage and communicate effectively. Facilitators included the good will and dedication of stakeholders, strong evidence base for change and the support of jurisdictions during the delay. We documented substantial implementation challenges, offering learnings for other countries transitioning to HPV screening. Sufficient planning, significant and transparent engagement and communication with stakeholders, and change management are critical.

Keywords: Australia; Cancer screening; Cervical cancer; Cervical screening; Evaluation; Government; HPV; Implementation research; Providers; Qualitative.