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What can we learn about cervical screening from the most remote place in the UK?

Posted on: Monday, 23rd March 2020 by Iona Stoddart, Prevention Project Lead

Iona Stoddart leads our West of Scotland team and she recently went on a cervical screening tour of the Western Isles. She’s shared the insights this unique part of the world gave her about access to cervical screening. 

Iona StoddartI was born on South Uist, a small island in the Western Isles of Scotland. Around 20,000 people live in the Western Isles. It’s only accessible by ferry or plane from the mainland of Scotland so it’s not regularly visited by health organisations. 

I lead the Cervical Cancer Prevention Programme for the West of Scotland here at Jo’s. Our aim of the trip was to understand what the specific barriers are in this area which stop people from booking an appointment. We wanted to speak to people living on the islands and one of the outcomes was to be able to take their points forward to the NHS and help to make some positive changes. I was there for nearly two weeks, hosting awareness stalls in community hubs with a member of staff from the NHS health improvement team. I worked with nurses and healthcare providers, and delivered training to community members so they feel equipped to share cervical health messages.

The Western Isles is a beautiful, welcoming place but it can be hard to imagine living there if you’re from a big city. For example, the smallest islands, Barra, has a population of just over 1000 people and there’s only one nurse on the island. It’s a very close-knit community, which is friendly and supportive. However, this type of rural setting presents its own specific issues when it comes to cervical screening.

What issues do the Western Isles face?

Western Isles cervical screeningOne of the biggest problems we heard about was actually getting an appointment. In some areas, a surgery only carries out screening on one particular day. When you live on an island and have no other option, such as a sexual health clinic, this can leave you waiting for a long time. We spoke to one woman who was waiting for six months for an appointment because of this particular issue. 

We heard about one community in which their nurse was off sick for several months. In that time, they got a locum nurse in and the uptake of tests rocketed up to close to 100%. Of course, knowing your nurse and being embarrassed isn’t the only reason people delay or do not attend. But it is one obstacle we can remove swiftly and give women one less thing to worry about. Working closely with the NHS health improvement team meant that we’ve been able to put this on their radar and they are now looking into swapping nurses between islands, in order to help more women feel able to attend their test.

This kind of close-knit community might find the move to HPV primary testing has a bigger impact. We know that there is a lot of shame and stigma which exists around the virus, despite it being something which almost every sexually active adult will come into contact with. Imagine then, your nurse being someone you’ve known since your childhood. Healthcare professionals raised the fact that this could amplify fears and concerns around discussing HPV and prevent a patient from getting the facts.

How can we break down these barriers?

I was able to attend two training sessions for healthcare professionals who carry out cervical screening and talk to them about the emotional side of a HPV diagnosis. It was a great opportunity to talk about potential reactions women may have and to encourage supportive and non-judgemental conversations. 

Scotland is moving to HPV testing this month, so spreading this health message before the changeover actually happens was fantastic timing as we know patients may be feeling confused or worried. 

A closely connected community means that messages spread quickly, so it was crucial to make sure the messages people hear about HPV testing are positive ones. This is why I trained groups of community members who were keen to help share this health message. We asked this group of people to talk to women they meet about cervical screening and HPV and gave them the tools to do this.

It was a really positive trip and a great opportunity to hear more women’s experiences.  Local, specific knowledge is crucial in order to break down different barriers which exist in different regions so it was fantastic to build on what we already knew about the Western Isles. Thanks to community members raising that they would like more out of hours appointments, as well as appointment reminders, these are things we are now taking forward with the NHS.

I’m looking forward to going back to the Western Isles to hopefully see the impact of this work and to train more community members in Uist, Harris and Barra. We will also be sharing the outcomes from this work with others who are working within rural communities throughout the UK.

Categories: cervical screening