Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review

Population-based cancer screening programmes can significantly reduce cervix, breast and colorectal cancer mortality and morbidity. While many countries have set up screening programs for these cancers, people do not always use them. It is vital to understand why people do (not) get screened to better plan effective interventions. This paper presents a rapid review of research to identify (1) common barriers and drivers to undergoing screening and (2) intervention components used to increase screening rates. Selection criteria for the review included English-language studies published 2000-2024. To be included for barriers and drivers of cancer screening attendance, studies had to address the factors why people do (not) attend screenings. To be included for interventions, studies had to assess interventions aiming to increase screening. Quantitative and qualitative studies were eligible. The research presented here focuses primarily though not exclusively on evidence from the WHO European Region. Barriers and drivers are categorised according to the COM-B model, namely capability, opportunity, and motivation-related factors. Key capability barriers included limited awareness, low health literacy, and forgetfulness; motivational barriers included negative beliefs, fatalism, and emotional factors such as fear, shame, or disgust; opportunity-related barriers encompassed cost, access constraints, time limitations, and sociocultural stigma. Drivers included perceived benefits, high self-efficacy, supportive provider communication, and social encouragement. Effective interventions were typically multicomponent, combining educational and access-enhancing elements. Educational strategies were most successful when interactive, culturally tailored, and skill-focused. Invitations and reminders, particularly personalised, physician-signed, or opt-out formats, improved attendance. Organisational changes-such as designated screening clinics, nonphysician-led delivery, and quality improvement systems-consistently enhanced uptake. Patient navigation and community-based approaches were beneficial for underserved groups. Home-testing facilitated colorectal and cervical screening participation when logistical barriers were minimised. Cancer screening uptake is shaped by intertwined behavioural, structural, and cultural factors. Interventions that address multiple COM-B domains-improving knowledge, motivation, accessibility, and cultural appropriateness-show the greatest promise. Tailoring strategies to local contexts and population needs is critical to achieving equitable screening coverage and reducing preventable cancer burden.