Enhancing equity and efficiency in cervical screening uptake: a multidisciplinary quality improvement initiative

Abstract

Background: Cervical cancer screening is vital for early detection and prevention, yet uptake remains suboptimal in diverse communities.

Local problem: Cauldwell Medical Centre reported cervical screening uptake rates of 54% (ages 25-49) and 62% (ages 50-64) by June 2022, both significantly below the national target of 80%, with a concerning 8 percentage point disparity between age groups.

Methods: Using quality improvement (QI) methodologies, including Plan-Do-Study-Act cycles and statistical process control charts, the team tested eight cycles of change grouped into three high-impact actions designed to improve accessibility, trust and personalisation of cervical screening services. Tests of change included culturally sensitive outreach, extended clinic hours and a self-booking system to enhance accessibility and engagement.

Results: This QI initiative achieved a marked reduction in age-related inequalities in cervical screening uptake. By the end of the intervention period (March 2023), screening rates increased from 54% to 69% among women aged 25-49 and from 62% to 72% among women aged 50-64, narrowing the gap from 8 to 3 percentage points-a 60% reduction in disparity. By the final monitoring week, uptake further increased to 73% (ages 25-49) and 82% (ages 50-64), demonstrating how structured QI approaches can amplify the effectiveness of existing healthcare processes.

Conclusions: This project highlights that systematically applying QI methodologies can effectively address healthcare inequalities, providing a scalable model for improving cervical screening uptake among under-represented populations.

Keywords: Continuous quality improvement; Health Equity; Healthcare quality improvement; Quality improvement.

Figure 1. Driver diagram illustrating the aim, primary and secondary drivers, and associated change ideas designed to increase cervical screening uptake among 25–64 years old at Cauldwell Medical Centre. The project focused on improving capacity, opportunity and patient experience to drive sustainable change. QI, quality improvement; SOP, Standard Operating Procedure.

Figure 2. Line chart showing the improved percentage of cervical screening uptake at Cauldwell Medical Centre, segmented by age group. Following the launch of extended access clinics and self-booking (1), culturally tailored outreach (2) and piloting of personalised support and self-sampling (3), uptake increased across both age groups, with a sustained narrowing of the gap between cohorts in the postintervention period. QI, quality improvement.

Figure 3. An Individuals (I) chart displaying the number of patients attending cervical screening appointments per week at Cauldwell Medical Centre. Following the introduction of three high impact actions—(1) extended access and self-booking, (2) culturally tailored outreach and (3) personalised support with self-sampling—weekly attendance increased, with a sustained shift above the baseline average observed. QI, quality improvement.