Addressing inequalities in screening
We must address barriers and facilitate access across the screening and treatment pathway. In doing so, we can reduce inequalities in screening and improve health outcomes.
What works to increase screening uptake in under-served groups?
Research tells us some ways to increase access to screening and uptake in under-served groups. A recent systematic review by the Office for Health Improvement and Disparities found strong evidence in support of the following interventions.
- Appointment reminders which include the exact time of the appointment
- GPs identifying those that do not respond and issuing letters to them.
The review also found some evidence in support of annual reminders for non-responders or pre-appointment reminders by post or text message. There was also weaker evidence in favour of interventions such as GP endorsed invitations or telephone reminders for non-responders.
Other research makes recommendations for specific screening programmes. For example, an unpublished systematic review by researchers in Scotland of the 'factors influencing attendance at AAA screening and interventions to reduce inequalities' recommended the following.
- Following an invite for screening, to provide additional support and personal reminders to men less likely to attend
- For services to consider travel time to clinics, especially for men less likely to attend, and public transport use
- To work with colleagues who are also interested in improving men's engagement with healthcare. For example, discussing screening at times when men attend other health or social care services, such as GP or acute hospital services.
For cervical screening, the systematic review by the Office for Health Improvement and Disparities found strong evidence to support self-testing for human papillomavirus (HPV) for individuals who do not respond to a cervical screening appointment within primary care.
Despite this, the evidence-base remains limited for reducing inequalities in all under-served groups. It is important to evaluate interventions to address inequalities in screening and for the findings to be disseminated, to inform effective intervention.
Current activities to address inequalities in screening within the Special Health Boards
The Special Health Boards include NHS National Services Scotland, Public Health Scotland, and Healthcare Improvement Scotland. Each works to support screening and deliver system level change to reduce inequalities in screening.
Public Health Scotland develops high-quality information 'for screening awareness' and 'invitation to screen'. It produces these in four core languages - with further translations available on request - as well as easy read, large print, and audio formats. Third sector organisations are included in the development process. The development of accessible information and communications in on-going.
Several national programmes and projects are already happening, which will help address screening inequalities. These include changes to national IT systems to improve engagement with participants (e.g., better use of text messaging). Appendix 3 provides an overview of current national projects.
Current activities to address inequalities in screening within the 14 NHS Boards
Each of the 14 NHS Boards play an important role in tackling inequalities. Uptake of the screening and treatment pathways varies between boards. Many of the barriers to screening are shared. There may also be some barriers specific to certain geographic locations.
NHS Boards are well placed to understand local population groups and needs. They can work together with partners to respond to local needs, by addressing barriers and facilitating access. This includes working with local communities, local authorities, health and social care partnerships, other public sector agencies, independent sector organisations, third sector organisations and academia.
A great deal of work is undertaken by NHS Boards to reduce inequalities in screening. As an example of this, Appendix 4 provides an overview of local interventions funded by the Scottish Government Screening Inequalities Fund. To help us build the evidence-base and understand what works to reduce inequalities in screening, we need to support more robust evaluation of local interventions and improve mechanisms for shared learning.
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