Background: Australia has recently introduced a new screening program for cervical cancer. There has also been a decline in participation rates for cervical screening. Aim: To complete a systematic literature review of the factors that prevent Australian women from participating in cervical screening. Methods: Authors searched CINAHL, Medline, SCOPUS and the Cochrane Library to obtain articles discussing Australian women's self-identified barriers to cervical screening. Quantitative studies published in peer-reviewed journals after 1991 were considered. PROSPERO Registration Number: CRD42018105028. Results: The final search produced 1749 studies, with 13 quantitative papers included in the narrative synthesis after screening by two independent reviewers. No articles were excluded due to bias. Discussion: Self-identified barriers to screening were categorised into personal, practitioner, test-related and logistical factors. The most commonly stated barriers included lack of time, embarrassment, fear of results, irrelevance and male health professionals. The use of HPV triage in cervical screening was not a barrier to screening, however, some women regarded self-collected HPV testing as a barrier. Barriers to self-collection included desire for the general practitioner to complete the test, fear of doing the test incorrectly, wishing to include it in a general checkup and concerns about the test itself. Conclusion: A variety of personal, practitioner, test-related and logistical barriers negatively impact the screening participation of Australian women. Further research into barriers in the Australian population, and women's attitudes towards HPV testing and self-collection is required to create effective health interventions to improve participation in cervical screening.

ObjectivesTo investigate women’s understanding and attitudes towards the National Cervical Screening Program (NCSP) and to explore methods to improve screening participation.DesignSemi-structured face-to-face interviews were conducted through convenience and snowball sampling. Thematic analysis occurred using the interpretivist framework.SettingA private general practice in North Queensland.ParticipantsWomen between the ages of 18 and 74 who attended the general practice were eligible to participate. Fourteen women between 20 and 58 years old were interviewed.ResultsParticipants were concerned that the new NCSP would miss cancer due to longer screening intervals and reliance on primary human papilloma virus (HPV) testing. They believed that young women are at increased risk of cervical cancer, due to perceived HPV vaccine ineffectiveness and parent objection to vaccination. Most participants were not agreeable to self-sampling and preferred their doctor to perform screening. Personal and practitioner beliefs influenced a woman’s screening participation. Personal factors include being healthy for themselves and their family, previous abnormal smears and family history of cancer. Emphasis was placed on feeling ‘comfortable’ with their practitioner which included patient rapport and gender preference. Proposed methods to improve cervical screening included education programmes, advertising campaigns, general practitioner interventions and improving accessibility.ConclusionsIt is apparent that women are hesitant about the new NCSP. However, when provided with additional information they were more amenable to the changes. This highlights the need to improve awareness of cervical screening and the new NCSP.

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Australia may be the first country to eliminate cervical cancer as a public health issue due to its longstanding National Cervical Screening Program (NCSP) and the early introduction of the Gardasil vaccine for Human Papillomavirus (HPV) into the National Immunisation Program Schedule. 1 In December 2017, Australia updated the NCSP by replacing bi-annual pap smears with a 5-yearly Cervical Screening Test (CST) for Human Papillomavirus (HPV). 2,3 Women now commence cervical screening at 25 years old. This delay in screening is to prevent the overscreening and overinvestigation of young women as cervical screening has not reduced the incidence or mortality rate from cervical cancer in women under 25 since the introduction of the NCSP in Australia. Furthermore, the new NCSP incorporates the opportunity for self-sampling among eligible women. Women over 30, who are under-and never screened, can be offered a self-collected high vaginal swab instead of a traditional pap smear. 2 As the new NCSP was implemented 2 years ago, there is minimal research regarding Australian women's awareness and attitudes towards the new guidelines. A recent survey by the Australian Cervical Cancer Foundation (ACCF) identified that only 23% of women were aware that the CST should be performed every 5 years. 4 A study of