Toward equitable cervical screening: a qualitative study of under- and never-screened groups in Australia

Australia’s National Cervical Screening Program recommends 5-yearly HPV screening for those aged 25-74 years, with around three-quarters of eligible participants being screened in the past 5 years. Some population groups in the community are under-screened, missing opportunities to prevent cervical cancer or detect it early. This qualitative study examined past experiences with or barriers to engaging in cervical screening for women and people with a cervix from specific under- and never-screened groups and aimed to understand the underlying socio-ecological factors that lead to under- and never-screening. We conducted 55 semi-structured interviews between October 2023 and November 2024 with screen-eligible women and people with a cervix, including those from refugee backgrounds; who identify as LGBTQ+; with physical and/or sensory disability; and/or from Pacific Islander communities. Findings were mapped to the socio-ecological framework and indicate that intrapersonal (e.g., body shyness and discomfort), interpersonal (e.g., negative interactions with healthcare providers), and health system (e.g., inaccessible and non-inclusive services) factors impacted screening decisions. Achieving genuine equity for cervical screening requires more awareness around the importance of screening, trauma-informed and person-centred care, and addressing wider systemic barriers to ensure that everyone is given the choice to screen in a way that is accessible, culturally-sensitive, and inclusive. • Past cervical screening experiences shape future screening decisions • Cervical screening is impeded by inaccessible health system barriers • Trauma-informed, person-centred, and inclusive care strategies needed for screening • Calls for equity-driven public health approaches