A systematic review of the Factors Influencing the Uptake of Cervical

Cancer Screening among Reproductive Women in the United Kingdom

Table of Contents
A systematic review of the Factors Influencing the Uptake of Cervical Cancer Screening among
Reproductive Women in the United Kingdom.............................................................................................0
Introduction.................................................................................................................................................1
Background.............................................................................................................................................2
Keyword..................................................................................................................................................3
Literature Review (Systematic review).......................................................................................................3
Aim..........................................................................................................................................................5
Objectives................................................................................................................................................5
Justification Of Design................................................................................................................................5
Methodology...............................................................................................................................................6
Method....................................................................................................................................................6
Research Design..................................................................................................................................6
Criteria for Selecting Studies into Review...........................................................................................7
Comprehensive Search........................................................................................................................9
First and Second Selection of Studies................................................................................................10
Assessment of Methodological Quality / Risk Bias Assessment.......................................................11
Data Extraction..................................................................................................................................12
Data Analysis....................................................................................................................................12
Ethics.................................................................................................................................................12
Conclusion.................................................................................................................................................13
Reference...................................................................................................................................................15

Introduction
The second most prevalent type of cancer in females worldwide is cervical cancer, with an
estimate of 600,00 new cases in 2021, recording about 28,000 deaths annually. Most cases of
cervical cancer occur among citizens of developing countries, which represents 15% of cancers
affecting women globally. United Kingdom women must exercise early screening for cervical
cancer, this can be achieved by the frequent use of cytology test which is also referred to as Pap
Smears. Early screening will prevent further growth of the cervical cancer cells in the woman’s
body and help detect the cancerous cells at an early stage; this also propagates a high rate of
survival for its victims. Despite numerous initiatives educating women in the UK on the benefits
of early cervical cancer screening, not all women in the UK take advantage of the knowledge,
resulting in deaths among women due to late diagnosis. Cervical cancer is the most frequent type
of cancer in women, despite the fact that it is one of the most treatable and preventive
malignancies. If most women in the UK undergo regular cervical cancer screening and received
the human papillomavirus (HPV) vaccination most deaths from cervical cancer would be
avoided. Fear, humiliation, inadequate education, and cultural beliefs are just a few of the
barriers that hinder women from seeking early cervical cancer screening and visiting an HPV
vaccination center. The goal of this study is to conduct a systematic analysis of the factors that
influence cervical cancer screening uptake among reproductive women in the United Kingdom.

Background
In the United Kingdom, about 3000 women are diagnosed with cervical cancer, and about 1000
women die from the disease every year (Devarapalli et al., 2018). The abnormality of cervical
cancer can be prevented if detected at an early stage, therefore UK women are greatly advised to
visit a cervical cancer screening examination centre within the National Health Service Cervical
Cancer Screening Programme (NHSCSP) offered by the United Kingdom’s National Health
Service (Harper et al., 2021). Magsino (2020) states that it is important that participation in
cervical cancer screening examinations is taken seriously by UK women because a Pap Smears
test provides early cervical cancer detection, and cervical cancer has a high rate of a cure if
detected at an early stage. The NHSCSP is a nationally organised programme that gives women
in the United Kingdom a Pap Smear test at time intervals, cell samples will be taken from the
cervix, and examined under a microscope to detect its abnormalities (Munoru, Gitonga and
Muraya, 2019). Rules on the age of the first invitation are defined by the NHSCSP, intervals in
the age of the first invitation are different in Wales, Scotland, and England, because the different
country’s National Health Service (NHS) is responsible for the management of the programme in
their respective countries, the age of the first invitation depends on the part of the United
Kingdom the woman lives and resides in; it is 20 years old in Scotland, Wales and, 25 years old
in England (Luft et al., 2021).

Keyword
Cancer, Pap Smears, Cervical cancer, National Health Service NHS, Women, United Kingdom.

Literature Review (Systematic review)

Economic variables affecting the demand for health care services in general, and preventive
medical care are based on human capital factors, these factors consider training, education, and
investment in primary health care as the most important, which raise human productivity and
health (Stuart and D’Lima, 2021). The age of a woman can have a diverse effect on the response
to cervical cancer screening, and visiting a public health centre. It is common knowledge that the
health of a woman depreciates as age increases, therefore the demand for visits to a public health
centre and uptake of cervical cancer screening should also increase (Wearn and Shepherd, 2022).
The life span of older women is shorter compared to that of younger women, therefore, older
women are less able to visit the public health centre as a result of the decrease in mobility due to
physical handicaps (Tarver and Haggstrom, 2019). Munoru, Gitonga and Muraya (2019) noted
that another possibility is that older women visit the public health centre more frequently because
of the existence of other chronic abnormalities in the body, and thereby have little or no time for
cervical cancer screening examination because she focuses more on treating the existing chronic
conditions, therefore, the effect of age in determining the frequency of the clinical visit for
cervical cancer screening cannot be truly predicted. A cervical cancer screening exercise
campaign should be carried out to increase awareness of the importance of disease prevention
including cervical cancer screening examination, and general health importance among women
in the UK (MacLaughlin et al., 2022). The woman's household income also has an effect on how
frequently she visits a public health center for cervical cancer screening examinations, an
increase in household income increases the demand time for perfect health (Luft et al., 2021).
However, the effect of increased household income is weak in the United Kingdom because
having a cervical cancer test screening and visiting the public health centre is free of charge
(FOC) compared to other developed, and developing countries (Kirubarajan et al., 2020).

Non-economic determinants may also have an effect on the uptake of cervical cancer screening
and visits to the public health center (Abdi et al., 2020). The public health care services
stakeholders play an active role in being the first point of contact by participants in the United
Kingdom health care system, it is the duty of the health care service providers to give adequate
advice and information about the necessity of an early cervical cancer screening examination, the
health service providers can explain to locals the importance of regular screening exercises
because that would lead to the early detection of the abnormalities (Ampofo et al., 2022).
Smoking is related to poor health behaviours, and women who smoke show poor health attitudes
toward preventative behaviours, women who smoke have a low probability of using health care
services, such as keeping up with doctor’s appointments, therefore, it is predicted empirically
that smoking influences negatively on early cervical cancer screening examination (Christy et al.,
2021). The chances of a woman who has changed her address and residence receiving a letter of
invitation for the screening examination is low (Adunlin et al., 2019).

The possibility that a woman will visit a health care centre or go for a cervical cancer screening
Examination depends on several household and personal characteristics. The cohabitation status
of the woman is an effective indicator of social network and support, women who live with a
partner are more likely to exchange information about their health status than women who do not
live with a partner (Ampofo et al., 2020). Davidson et al. (2022) state that, having children in the
house can act as a constraint against regular health care centre visits and taking the cervical
cancer screen examination, studies show that women who have more children to cater for have
less concern about attending regular cervical cancer screening examinations, women who work
part-time have a higher opportunity to pay for the cost of going to the public health centre and
taking the examination compared to non-working and retired mothers. However, pieces of
evidence mixed with the systematic review focus on investigating the influence of employment
and culture on the uptake of the cervical cancer screening examination, showing that
unemployed and women of coloured could face cultural and emotional challenges towards the
cervical cancer screening examinations, this is because the woman may see the cervical cancer
screening examination as an invasive medical procedure (Fuzzell et al., 2021). One of the major
indicators for the possibility of taking the cervical cancer screening examination is ethnicity, and
records show that British women have a higher uptake of cervical cancer screening examination
than other ethnic groups in the United Kingdom (Seo, Li and Li, 2018). There has been no
research study on whether there are determinants that either increase or decrease the likelihood
of a visit to the public health centre and cervical cancer screening examination in a year, or
whether socioeconomic determinants have a separate effect on both uptakes (Munoru, Gitonga
and Muraya, 2019). The empirical analysis that follows is based on the human capital approach,
with education, household income, age, and health status as economic determinants, as well as
non-economic factors can also play a significant role in public health centre visits and cervical
screening examination uptake (Stuart and D’Lima, 2021). This research paper compares the
factors of a cervical cancer screening examination to the determinant of public health centre
visit, as well as if uptake of cervical cancer screening examination is higher.

Aim
To explore the Factors Influencing the Uptake of Cervical Cancer Screening among
Reproductive Women in the United Kingdom.

Objectives
a) To find out how the utilisation of cervical cancer screening examination is influenced by
human capacity in the United Kingdom

b) To examine the effect of socioeconomic factors on the uptake of cervical cancer screening
among reproductive women in the United Kingdom.

c) To create the influence of the public health care system on the utilisation of cervical cancer
screening examination in the United Kingdom

Justification Of Design
The following databases will be carefully searched: PubMed, Web of Science, SCOPUS,
CINAHL, Psychinfo, Google Scholar, Science Direct, and the Cochrane Library, all
observational studies in the United Kingdom that reported on cervical cancer screening use
and/or its determinants will be considered (Kirubarajan et al., 2021). Two writers will extract the
relevant information separately, implementing a consistent data extraction format, the Newcastle
Ottawa quality evaluation scale will be used to provide quality assessment standards for
prevalence studies (Magsino, 2020). To analyse the heterogeneity of studies, the Cochrane Q test
statistics and the I2 test will be adopted, the pooled prevalence of cervical cancer screening use
and the factors that are associated with it will be estimated using a random effects model of
analysis with 95 percent confidence intervals (CIs) (Munoru Gitonga and Muraya, 2019).
Methodology
Methods and techniques employed by the researcher in this study will be analysed, the research
study will describe the research design, sampling size, study area, and sampling techniques as
well as tools and methods used in the collation of data. Data tools and analysis will also be
analysed in the research study

Method
For this proposal, the Preferred Reporting Items for Systematic Reviews and Meta-Analysis
recommendation will be used for a systematic review and quality reporting.
Research Design
The strategy for this proposal will be a two-stage decision-making model in which the health
care system will assume responsibility for the cervical cancer screening examination procedure
(Tarver and Haggstrom, 2019). The model will be a determinant of the first stage of participants
visiting a primary health care service centre and the second step factor will be the uptake of the
cervical cancer screening examination. The two-stage decision factors will be modelled by a
sample selection model, the cervical cancer screening examination can be carried out in any
primary health care centre in the United Kingdom, or it will be done without participants visiting
the primary health service centre but by making an appointment with a specialised service, such
as a genito-urinary clinic or a family hospital, this will result in the possibility of getting a
cervical cancer screening examination without visiting a public health centre; and the public
health care service providers are not in the position of a gatekeeper (Magsino, 2020). According
to Munoru, Gitonga and Muraya (2019), visiting the public health centre is not essential for the
uptake of cervical cancer screening exercises, but they act as one of the determinants of a
cervical cancer screening examination for participants in the UK. Therefore, visits to the public
health service centre will be included as an explanatory variable in the prevention equation. An
adequate statistical model will be drawn to explain the joint determinants for the uptake of early
cervical cancer screening examination, determinants for the visit to the public health care service
centre in a year, and consider the endogeneity of public health centre visit’s binary endogenous
variables/non-observable factors (Wearn and Shepherd, 2022). Estimating the effect of a binary
endogenous variable on a binary outcome in the presence of an unobservable variable will be
achieved by using the statistical model called the recursive bivariate probit model. Non-
observable variables could be fear and anxiety on the part of the women or risk aversion, and
both variables influence the general health care services in the UK (Abdi et al., 2020). Adunlin et
al. (2019) suggest that the function of the estimated likelihood for the recursive bivariate probit
model will be done the same way as one of the regular bivariate probit models, although no
constraint is required to find the public health care services equation using the recursive bivariate
probit model, adding an excluded restriction may increase estimation efficiency. The cervical
cancer screening examination guidelines of the National Health Service Cervical Screening
Programme (NHSCSP) and former cervical cancer screening examinations are necessary for the
uptake, it is therefore sensible for the researcher to consider past responses to screening, because
of the likely increase of participants in the cervical cancer screening examination after three
years of the recommended time interval (Chua et al., 2021).

Criteria for Selecting Studies into Review

This research proposal will examine the usage of cervical cancer screening in the United
Kingdom or the predictive factors for cervical cancer screening (Adunlin et al., 2019). To
determine eligibility for inclusion in this review, all published and unpublished research through
April 7, 2020 that were reported in the English language will be retrieved (Chua et al., 2021).
However, this analysis will omit studies that reported cases on populations, surveillance data
(demographic health survey), and conference abstracts, as well as articles that did not provide
full access or did not provide the desired outcome (Fuzzell et al., 2021). The selection of articles
will be carried out in stages; two reviewers determined whether or not to include the retrieved
articles based on their title, abstract, and full-text evaluations (Kirubarajan et al., 2020). The
consensus will be used to resolve any disagreements that arose during the reviewers' selection
process. Following that, the complete texts of selected publications will be reviewed using the
previously established qualifying criteria. Only the full-text article will be maintained upon the
discovery of duplication (Christy et al., 2021).

Inclusion and Exclusion Criteria

For the purpose of this proposal, literature reviews included will be sourced randomly from
several online databases, clinical trials, experiments from cohort studies, and interviews with
reproductive women in the UK. The research proposal will contain books, articles, medical
journals that are published in the English language. Materials that will be left out will be articles
not published in English language, and materials not relating to the uptake of cervical cancer
screening among UK women
PICO component
To identify variables in the proposal the population, intervention, comparison, and outcomes
(PICO) structure will be used:

Category Inclusion Exclusion

Condition Publications that identify the
perception of cervical cancer
screening
Aim Programme publications that Diet intervention
screen women systematically programmes.
to select the ones with
cervical cancer
Choosing reports that deals
with cancer management.
Population Reproductive women from Women from below the age
eighteen years and above. of eighteen years old
Intervention Screening that involves the Prevention of women from
programmes that will create conducting CCS
awareness on the necessity of Screening not carried out in a
the uptake of cervical primary healthcare scenario.
screening examination
Screening conducted in a
public healthcare.
Comparator No CCS screening, detecting Components too rigorous to
normal care, with no be referred to as normal care
regulated groups with no that are also referred to as
intervention. active comparators
Outcome Enhance the quality of life, Behavioural outcome such as
physical looks, fitness, and physical workout.
everyday activities of life.
 Assessment of timing No follow up on respondents.
outcomes
Settings Primary healthcare settings, Research laboratory,
out-patient healthcare centres, correctional facilities, college
mobile phone / virtual reality. or university setting, mental
health clinic, and E.R
departments.
Study design Controlled clinical All other design
environment,
Region United Kingdom Anywhere aside the UK
Language English Language Other languages aside
English Language
Quality of study Good or Fair Poor or very poor

Comprehensive Search
The objectives of this systematic review and meta-analysis are to evaluate the pooled level of
cervical cancer screening utilisation and its indicators among reproductive-aged women in the
United Kingdom (Ampofo et al., 2020). The protocol will be registered with the International
Prospective Register of Systematic Reviews (PROSPERO), the University of York Center for
Reviews and Dissemination, and the University of York Center for Reviews and Dissemination
(MacLaughlin et al., 2022). Luft et al. (2021) state that the findings of this review will be
described in accordance with the checklist for Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA-P) 2009 statements. The researcher will search significant global
databases such as PubMed, Cochrane Library, Psych Info, Scopus, CINAHL, Web of Science,
Science Direct, Google Scholar, and African Journals Online for all published articles (Magsino,
2020). Additionally, manual searches on Google will mainly be conducted for unpublished
studies, additionally, a search will be undertaken for the bibliographies of previously discovered
research in order to obtain additional literature. Information will be extracted using the
Population, Interaction, Comparison, and Outcomes (PICO) search strategy (Munoru, Gitonga
and Muraya, 2019).
The sample of interest in this study was all qualified women in the United Kingdom for cervical
cancer screening, the outcome that was investigated was women's use of cervical cancer
screening (Stuart and D’Lima, 2021). The age of women, their educational and occupational
status, their knowledge of cervical cancer screening, their perceived susceptibility to and severity
of cervical cancer, and their history of sexually transmitted infections were all included as
predictor variables of cervical cancer screening utilisation in this study (Shin et al., 2022).
Results were compared for each predictor compared with the reference group indicated for that
indicator in each variable.

Electronic databases were searched for each of the PICO components using a keyword search
and MeSH criteria; "utilisation, uptake, cervical cancer, screening, and women of reproductive
age, as well as the United Kingdom" are among the keywords (Tarver and Haggstrom, 2019).
The Boolean operators "OR" and "AND" were also used to combine the search terms, the
research paper included extensive information on the PubMed search (Wearn and Shepherd,
2022).

First and Second Selection of Studies

This systematic review and meta-analysis include research on the usage of cervical cancer
screening in the United Kingdom that were both published and unpublished (Seo, Li and Li,
2018). The research identified a total of 850 articles, 250 duplicate records will be discarded, and
581 articles will be excluded based on their titles and abstracts (Ampofo et al., 2022). Following
that, a total of 38 full-text articles will be reviewed for validity using the inclusion and exclusion
criteria, however, four studies will be omitted leading to a shortage of the desired outcome, three
due to low quality, five due to demographic differences, and just one due to a lack of access to
the complete text, finally, the final quantitative meta-analysis included twenty-five publications
(Abdi et al., 2020).

Most of the research articles will be cross-sectional in nature. Twelve of these studies will be
facility-based cross-sectional (FBCS), whereas thirteen will community-based cross-sectional
(CBCS) (Adunlin et al., 2019). The review will enroll 18,067 women in order to determine the
incidence rates of cervical cancer screening, between 2016 and 2020 when the articles were
published (Devarapalli et al., 2018). The greatest sample size will be 5,823 women in a
nationwide study, while the smallest sample size will be 250 women in Ireland (Davidson et al.,
2022). All surveys were done in the United Kingdom's five geographical locations; four (16%)
studies will be conducted in England, nine (36%) in Wales, four (16%) in Dublin, four (16%) in
Scotland, two (8%) in Ireland, and one study was undertaken on a nationwide basis (Harper et
al., 2021).

Assessment of Methodological Quality / Risk Bias Assessment

The quality of the research studies will be determined using the Newcastle-Ottawa Scale (NOS)
quality assessment method, the technique is composed of three components: group selection,
comparability of study groups, and determination of exposure or outcome (Munoru, Gitonga and
Muraya, 2019). The tool's principal component will be rated on a five-star scale and a premium
will be placed on the methodological quality of each primary study, the third component of the
instrument is a two-star rating system that focuses on the comparability of each study
(MacLaughlin et al., 2022). The tool's final component was assessed on a three-star scale, and
will be used to assess the findings and statistical analysis of each original study (Magsino, 2020).
Three categories will be included in the NOS, each with a maximum score of nine points, each
study's quality will be determined using the following scoring algorithms: 7 points equaled
"excellent," 4 to 6 points equaled "average," and 3 points equaled "poor" (Wearn and Shepherd,
2022). To increase the validity of this systematic review result, we will include only primary
studies of moderate to high quality, two independent reviewers assessed the overall quality of
studies and extracted data using a defined data extraction format (Stuart and D’Lima, 2021). The
primary author, the year of publication, the region of the study, the sample size, the prevalence,
and the selected predictors of cervical cancer screening use will all be included in the data
extraction format (Kirubarajan et al., 2021).

The Egger's and Begg's tests with a p-value less than 0.05 will be used to assess publication bias,
the I2 statistic will be used to compare studies and a p-value less than 0.05 will be utilised to
indicate heterogeneity (Harper et al., 2021). Due to the presence of heterogeneity, the analysis
will be conducted using a random-effects model; Microsoft Excel will be used to extract data,
which will be then exported to Stata's 11th version for analysis, subgroup analysis will be
performed on the basis of geographic region, demographic characteristics, and study design or
type (Luft et al., 2021). Additionally, a meta-regression model will be utilised to identify the
sources of random variation in the research study based on sample size and publication year. The
impact of chosen determinant variables will investigated through the use of distinct meta-analytic
categories (Adunlin et al., 2019). The conceptual analysis will be visualised using forest plots
and the Odds Ratio (OR) as well as its 95% Confidence Intervals (CI). Furthermore, the
researcher did a sensitivity analysis to determine whether particular studies will have an effect on
the pooled prevalence estimates (Chua et al., 2021).

Data Extraction
The data for this research study will be retrieved using a Microsoft Excel data extraction table
that was modified from the Cochrane Data Collection Form to meet the research study's aims
(Munoru, Gitonga and Muraya, 2019). Extracted data for the research paper will include;
bibliographic material, Research objectives, research design (methodology and size of samples),
characteristics of participants (socio-demographic determinants), results, and conclusion which
includes research recommendation (Christy et al., 2021). A reviewer extracted the data, will be
then assessed by a second reviewer to guarantee quality. Any inconsistencies discovered will be
resolved through dialogue.

Data Analysis
The British Household Panel Survey (BHPS) is a social and economic research organisation, that
holds the data of participants visiting the primary/public health care centre, and cervical cancer
screening examination uptake for over 29 years (1992-2021), the BHPS represents more than
10,000 households as samples and every individual interviewed within the household should be
above 16 years of age (Kirubarajan et al., 2020). The British Household Panel Survey began its
first wave in 1991; at every wave undertaken by the BHPS, questions about participants visiting
the public health care service centre and cervical cancer screening examination will be raised
(Munoru, Gitonga and Muraya, 2019). For research study purposes, a female sample that is
imbalanced will is pooled together from Scotland, Wales, and England to garner the correct data
for the analysis, the analysis has used the available data from 1992 to 2003 and so information
for 17 waves will be available (Seo, Li and Li, 2018). United Kingdom women with National
Health Service (NHS) provision and private arrangements for cervical cancer screening
examination will not be included in the analysis, only women with sole access to the NHS will
be included (Shin et al., 2022).
Ethics
The Dean of Teeside University's Faculty of Health Sciences granted administrative clearance,
and the corresponding hospital management granted authorisation for sample collection
(Davidson et al., 2022). Moreover, the study will be authorised by the ethical committee of
Teeside University's faculty of health science institutional review board (Christy et al., 2021).

The study's purpose is to give participants who will be asked to complete a standardised
questionnaire about their sociodemographic traits, sexual and reproductive histories. Anonymity
and confidentiality will be maintained, and each participant signed a verbal and written consent
form (Munoru, Gitonga and Muraya, 2019).

Conclusion
This research study provides sustainable evidence that can guide policy and program actions
geared at influencing factors, in the United Kingdom, cervical cancer screening is mandatory for
reproductive women. by locating and synthesising results from existing primary studies. Cervical
cancer screening among reproductive women in the United Kingdom is influenced by a complex
interaction of socioeconomic, structural, and individual factors, according to this study. Equally,
there is a crucial need to transform this population's high knowledge and attitudes towards
cervical cancer screening examination. However, improving cervical cancer screening
examination outcomes in the UK requires developing holistic strategies that address both health
system and individual variables impacting reproductive women, such as low-risk perception and
fear of a favourable result. As a result, improved screening habits among this group of
reproductive women are likely to cause an Increased cervical cancer screening tests among
women with whom they engage in the United Kingdom.
Reference
Abdi, H. I. et al. (2020) ‘Cervical cancer screening among immigrant and refugee women:
Scoping-review and directions for future research, Journal of Immigrant and Minority
Health, 22(6), pp. 1304-1319.

Adunlin, G. et al. (2019) ‘Barriers and facilitators to breast and cervical cancer screening among
immigrants in the United States’, Journal of immigrant and minority health, 21(3), pp. 606-658.

Ampofo, A. G. et al. (2020) ‘A cross-sectional study of barriers to cervical cancer screening

uptake in Ghana', An application of the health belief model. PloS one, 15(4), p. 0231459.

Ampofo, A. G. et al. (2022) ‘Improving knowledge, attitudes, and uptake of cervical cancer
prevention among female students: A systematic review and meta-analysis of school-based
health education’, Gynecologic Oncology.

Christy, K., et al. (2021) ‘Understanding Black Women's Perspectives and Experiences of
Cervical Cancer Screening: A Systematic Review and Qualitative Meta-synthesis’, Journal of
health care for the poor and underserved, 32(4), pp. 1675-1697.

Chua, B. et al. (2021) ‘Barriers to and facilitators of cervical cancer screening among women in
Southeast Asia: a systematic review’, International journal of environmental research and
public health, 18(9), p. 4586.

Devarapalli, P. et al. (2018) ‘Barriers affecting uptake of cervical cancer screening in low- and
middle-income countries: A systematic review’, Indian journal of cancer, 55(4), p. 318.

Davidson, N. et al. (2022) ‘Access to preventive sexual and reproductive health care for women
from refugee-like backgrounds: a systematic review’, BMC public health, 22(1), pp. 1-37.

Fuzzell, L. N. et al. (2021) ‘Cervical cancer screening in the United States: Challenges and
potential solutions for underscreened groups’, Preventive Medicine, 144, p. 106400.

Harper, D. M. et al. (2021) ‘Cancer risk perception and physician communication behaviors on
cervical cancer and colorectal cancer screening’, Elife, 10, p. 70003.

Kirubarajan, A. et al. (2020) Barriers and Facilitators for Cervical Cancer Screening Among
Young Women: A Systematic Review
Kirubarajan, A. et al. (2021) ‘Barriers and facilitators for cervical cancer screening among
adolescents and young people: a systematic review’, BMC women's health, 21(1), pp. 1-13.

Luft, H. et al. (2021) ‘An integrative literature review of barriers and facilitators to cervical
cancer screening among refugee women in the United States’, Health care for women
international, 42(7-9), pp. 992-1012.

MacLaughlin, K. L. et al. (2022) ‘Awareness and Support of Clinician-and Patient-Collected

Human Papillomavirus Testing for Cervical Cancer Screening Among Primary Care
Clinicians’, Women's Health Reports, 3(1), pp. 10-19.

Magsino, L. (2020) A Systematic Review on the Factors Influencing Human Papillomavirus

Vaccination Uptake among Asian Americans and Pacific Islanders in the US.

Munoru, F. Gitonga, L. and Muraya, M. (2019) ‘Integration of cervical cancer screening services
in the routine examinations offered in the Kenyan Health Facilities: a systematic review’, Open
Journal of Obstetrics and Gynecology, 9(05), p. 656.

Seo, J. Y. Li, J. and Li, K. (2018) ‘Cervical cancer screening experiences among Chinese
American immigrant women in the United States’, Journal of Obstetric, Gynecologic &
Neonatal Nursing, 47(1), pp. 52-63.

Shin, H. Y. et al. (2022) ‘Association of Late Marriage and Low Childbirth with Cervical
Cancer Screening among Korean Women: Results from a Nationwide Survey’, Cancers, 14(2),
p. 327.

Stuart, G. and D’Lima, D. (2021) ‘Perceived barriers and facilitators to attendance for cervical
cancer screening in EU member states: a systematic review and synthesis using the Theoretical
Domains Framework’, Psychology & Health, pp. 1-50.

Tarver, W. L. and Haggstrom, D. A. (2019) ‘The use of cancer-specific patient-centered

technologies among underserved populations in the United States: systematic review’, Journal of
medical Internet research, 21(4), p. 10256.

Wearn, A. and Shepherd, L. (2022) ‘Determinants of routine cervical screening participation in

underserved women: a qualitative systematic review’, Psychology & Health, pp. 1-26.