How do women experience the UK cervical screening programme, from receiving an invitation to attending their first smear test? A narrative analysis of blog posts.

Problem

In 2019, the number of women attending cervical screening in the United Kingdom fell to its lowest in 20 years. During the COVID-19 pandemic, numbers accessing screening have fallen further. This study aimed to understand patient experience of the UK cervical screening programme, particularly factors influencing first attendance for screening. Existing qualitative literature on patient experience of the screening programme is limited, and no study has followed the narrative arc of the individual patient. Online narratives have also not been studied before in cervical screening, and these are especially relevant since during the pandemic, the public are accessing more health information online and through social media, with current estimates showing that the average UK adult spends an extra hour online compared with before the pandemic.

Approach

Pre-pandemic, a Google search for Blogspot and WordPress blogs, the two most widely used blog hosting sites, found twenty-nine relevant blog posts once inclusion / exclusion criteria were applied, of which three were analysed. Further searches were performed to identify experiences during the pandemic and two relevant blog posts were found; one was analysed.

The four blog posts were configured using an emplotment approach adapted from Polkinghorne (1995). This allowed each person’s narrative to be kept whole and analysed sequentially from start to finish.

Findings

Four plots were identified:

1. the smear test as a rite-of-passage: the author began to take ownership of her health as an adult, and even offer support to others

2. the discrepancy between expectations and real-life: the author repeatedly expressed surprise that the smear test was not as bad as the horror stories in her mind

3. a collaborative approach to preparing for and attending screening: key players supported the author throughout the experience of the screening programme

4. many unknowns: the author’s anxiety around screening was magnified by the unknowns of the pandemic and she wrote to inform the reader of what to expect

Consequences

Whilst narrative analysis does not produce generalisable findings, it does provide unique insight into individual patient stories. Understanding the patient narrative arc will enable primary care professionals to think holistically about their patients, their complex fears and motivations, and improve their conversations with patients concerned about screening.

As patients are spending more time online during the pandemic, it is important for clinicians to understand the type of health promotion material their patients will encounter from peer-to-peer sources such as blogs and social media, and how this influences their health behaviour.

Further research is needed into negative experiences and minority groups who face more barriers to screening. In addition, there was a paucity of blog posts found during the pandemic; further research could identify other pandemic-specific narratives.