The role of non-medical providers in increasing access to cervical screening: a scoping review

Abstract

Introduction: Involving non-medical providers (NMPs) in cervical screening interventions could be a promising strategy to increase cervical screening participation among never or underscreened populations. We undertook a scoping review of published literature to explore the potential role of NMPs in increasing cervical screening participation.

Methods: We searched three databases (MEDLINE, EMBASE and CINAHL) to identify relevant scientific research articles published between 2016 and 2024 and extracted data using a standardised extraction tool.

Results: Our review identified 35 studies (randomised controlled trials (RCTs): n=12, non-RCTs: n=23) from a breadth of geographical and country-level income settings including Australia and New Zealand (n=3), Africa (n=7), Asia (n=4), Europe (n=3) and North (n=15) and South (n=3) America. NMPs in the included studies were community health workers, nurses and midwives; and their key roles involved identifying and recruiting target populations, delivering health education and raising awareness of cervical screening, facilitating self-sampling and providing navigation and follow-up assistance. Most studies included screening participants aged ≥30 years, who were underscreened, not pregnant, from ethnic minority populations, and living in rural or remote communities. NMP-facilitated cervical screening interventions were largely feasible and acceptable among target populations. Compared with the standard of care, which did not involve NMPs, NMP-facilitated interventions generally demonstrated an increased uptake of cervical screening in RCTs (n=11 out of 12) with relative increases ranging from 1.11 to 42.73. In four RCTs, where NMPs facilitated self-sampling, cervical screening uptake rates ranged from 32.0% to 81.0%. Most non-RCTs (n=18) involved NMPs in facilitating self-sampling, with screening uptake rates ranging from 9.0% to 100.0%. Key strategies identified were capacity-building of NMPs through training, and employing outreach strategies to reach underscreened women.

Conclusion: NMPs could play a wider and an important role in cervical screening, particularly in the context of self-sampling and have the potential to increase access and equity in cervical screening.

Keywords: Cancer; Health Personnel; Health education and promotion; Prevention strategies; Screening.