Improving access to cervical screening: A case study of a community clinical van outreach project

Despite the progress made through screening programmes and the widespread availability of services, uptake continues to fall short of national targets. A variety of barriers are contributing to these challenges, including lack of awareness, fear, cultural beliefs, difficulties with access, and previous negative experiences within healthcare settings. Each of these factors plays a significant role in lowering participation rates and perpetuating disparities.

This project aimed to address the decline in cervical screening uptake by identifying barriers people faced to accessing cervical screening in Kirklees and implementing targeted, evidence-based interventions to improve engagement.

In 2023/2024, Kirklees Council, Public Health collaborated with Homes and Neighbourhoods Housing and community champions to gather valuable feedback from residents about the obstacles they face in accessing cervical screening.

The main barriers identified included limited time, fear, unsuitable appointment times, the need for reassurance that a culturally and religiously aware female clinician would carry out the screening, and the preference for someone who could communicate in languages other than English.

Being busy

• "My children can't attend with me and I can't leave them anywhere as they are under four years old."
• "The said appointment times are often inconvenient because I have family commitments."

Fear

• "I am worried and anxious about the test and I'm fearful of the results."
• "I am a bit scared thinking I might get cancer as my mother did."

Accessing appointments

• "I forget to make the appointments. I feel that it's out of sight out of mind. It would be easier to be contacted to have the screening."

Embarrassed

• "I'm embarrassed about the smear test. It's the fear of the unknown and male medical staff completing the procedure."
• "After a previous smear test I came out and felt invaded and slightly shocked."

Family

• "When I got my first letter I was married. I asked my husband about if I needed to go and he said it's not important. Don't bother going there."
• "I am very aware of attending screening as previously a family member had suffered with cervical cancer."

Screening letter

• "If I was sent a letter with a pre-arranged appointment date/time already given. I would be more likely to attend rather than having to ring up and make an appointment. I put it off as I don't really want to go."
• "I always ignore the appointment notifications but now I will go and read the online information."

Pain

• "I haven't attended my most recent appointment as las time it was painful."
• "I'm worried about the pain because I have never had a test before."

People who identified that they lived in deprivation deciles 1-3 were more likely to speak about language difficulties in relation to cervical screening.

• "I’m embarrassed to talk about it especially as there are language barriers, it’s a bit taboo and I don’t have the confidence to go."

People who lived in deprivation decile 2 were more likely to state that they were too busy to attend the appointment.

• "I routinely forget to book the appointments, plus I also put it off and do not prioritise the appointment."

People who identified as Asian were most likely to report that they had challenges with, making appointments, being embarrassed, worried about uncomfortable procedures and language barriers.

People who identified as White were more likely to talk about age barriers and the screening letter/notification. 

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I did not attend my appointment because...

In response to these findings, Kirklees Public Health secured funding in 2025, from the West Yorkshire and Harrogate Cancer Alliance, to pilot mobile screening via the use of a clinically equipped mobile van, aimed at increasing uptake and addressing the barriers highlighted by the community. The cervical screening service was offered to all who were due or overdue for their screening, regardless of age cohort.

The clinical van visited eight community locations across north and south Kirklees during March and April 2026. The project aimed to make cervical screening more accessible, particularly in areas where uptake has historically been lower. Drop ins for screening were available between 9.00am and 4.30pm.

Kirklees Council’s Public Health team worked closely with Locala, Primary Care, VCSE and community organisations, fostering a robust system partnership. 

The project offered not just cervical screening, but also support, information, and an approachable space for those with questions, due or overdue appointments. This drop-in model has proved invaluable, providing flexible access and addressing barriers to care.

The project linked to several of Kirklees council priorities. 

The clinically equipped mobile van was successful in increasing screening uptake. Notably, there was increased participation among previously under-screened groups, indicating that tailored, culturally sensitive approaches were effective in addressing barriers.

Feedback from participants highlighted improved understanding of the screening process and reduced anxiety as key factors influencing decisions to attend.

Drop ins were attended by those who were due appointments, had missed recall appointments and those attending cervical screening for the first time (newly eligible or previously unengaged with the programme). These attendances are key to the prevention of cancer. 

A number of positive screens were also detected, meaning that those women are now receiving relevant health care and support. Women diagnosed with cervical cancer can experience physical, psychological, social, financial and reproductive issues. 

Women commented that the ease of attending (bringing a mobile clinical service directly into local neighbourhoods in accessible locations) and the availability of drop in screening meant they could attend opportunistically and flexibly around their work/home commitments.

The pilot was also successful in reducing emotional barriers and improving accessibility for diverse communities.

Those attending for the first time commented that it had been a positive and comfortable experience, particularly the warm and friendly nature of the female clinician.

Many also commented that they highly valued a culturally aware clinician able to communicate .

• Partnership working between the council, community partners and the Cancer Alliance 
• Bringing services into local communities increases uptake
• Flexibility of drop-ins increase uptake
• Culturally sensitive clinical support is key.

Rachel Spencer-Henshall, Director of Public Health at Kirklees Council, said:

“We are really encouraged by the response to our mobile cervical screening pilot. Feedback shows that bringing the service directly into communities helped remove some of the barriers that can stop people from attending."

Dr Nabanita Ghosh, Community Gynaecologist and Women’s Health Specialist, said: “It was encouraging to meet so many people who had been meaning to book their screening but found it difficult to attend their GP practice. The mobile unit created a friendly, supportive environment and many told us they felt reassured after attending.

Debbie from Lindley said “I saw it on Facebook in the morning while I was making a cuppa and thought right, I’ll go now. I just didn’t get round to booking.”

Mrs Ahmed from Huddersfield said “I got a text message from my GP telling me about it. It’s difficult finding time and fitting it around work and family. The staff really put me at ease, and it was really quick.”

Others shared that they were overdue for screening and a drop in opportunity in their community was ideal.

Although we continue to face some challenges in reaching certain populations, this project has established a solid foundation for ongoing improvement. Overall, the findings reinforce the importance of targeted interventions and collaborative working to reduce inequalities and increase access to preventative health services.

The pilot will be rolled out further across Kirklees to reach more communities, including a focus on reaching people with learning disabilities.