Investigating the Acceptability of Cervical Screening and Self‐Sampling in Postnatal Women at the 6‐Week Postnatal Check‐Up: A Qualitative Study

TL;DR

This study explores whether offering cervical screening at the 6-week postnatal check-up is acceptable to new mothers, finding that it could be feasible but may be too soon for some.

Contribution

The first qualitative study to explore postnatal women's views on cervical screening and self-sampling at the 6-week check-up.

Findings

Women perceive their health as less of a priority than their baby's health in the postnatal period.

Offering cervical screening at the 6-week postnatal check-up is viewed as a feasible opportunity for improving screening uptake.

Some women feel they may not be ready for screening so soon after childbirth.

Abstract

There is a lack of evidence to support UK and international clinical recommendations to delay cervical screening to 12‐weeks postnatal. In previous studies, half of women were out of date for screening by the end of pregnancy and the majority would be more likely to take up cervical screening, if offered at the 6‐week postnatal check‐up. We explored views about postnatal cervical screening the acceptability of offering cervical screening, using conventional and urine self‐sampling, earlier within the postnatal period.

A cross‐sectional qualitative design was used with recruitment from a larger questionnaire‐based study. Twenty‐six online semi‐structured interviews were conducted with 26 pregnant or recently pregnant participants. Interviews were transcribed and pseudonymised. A topic guide was developed, and data analysed using inductive reflexive thematic analysis.

Three themes were generated from qualitative analysis of verbatim interview transcripts: 1) A window of opportunity; 2) Am I ready yet? Postpartum recovery; and 3) Neglect of women's health in and around pregnancy. Overall, there was a perception that women's health was not a priority in the postnatal period compared with their babies.

This is the first study to use qualitative interview methods to explore women's views about the offer of cervical screening alongside the postnatal check‐up. Results support the feasibility of a clinical trial to test the accuracy and effect on uptake of offering cervical screening at the postnatal check‐up, although recognised it might be too soon for some. This should be considered in future feasibility research that includes assessment of concurrent acceptability.

This study was performed following focus groups in a quality improvement project, designed to increase uptake of cervical screening in women and people who were pregnant or recently pregnant. The suggestion for combining cervical screening with the routine 6‐week postnatal follow up was an idea generated by new parents and GP practice staff. The Somerset Maternity Voices group provided feedback on study materials, including the consent form and posters. The semi‐structured interview topic guide was designed following free‐text comments in the pre‐PINCS web‐based survey, results of which are published separately. Female pregnant and recently pregnant people, regardless of current gender identity, were included in this study. In line with the Royal College of Obstetricians and Gynaecologists language guide, we will use ‘women’ to describe participants.

Trial was registered with the National Institute for Health and Care Research Central Portfolio Management System (CPMS ID: 55489) and https://bepartofresearch.nihr.ac.uk/.