A Missed Opportunity? How Behavioural Science Can Contribute to Cervical Cancer Prevention

Swatting up on the most up to date cervical cancer facts and statistics in preparation for our social media posts this week, we have found ourselves contemplating once more how we at Caja can continue to support the life-saving preventative measures that are already in place across the NHS.??

The impact of HPV vaccinations and screening programmes across the UK is clear. Since the HPV vaccine was introduced in September 2008, high-risk HPV infections in 16-21-year-old women has dropped by 90%. As for screening, it is estimated that more than 8 in 10 of cervical cancer-related deaths could be prevented by regular tests. However, despite the evidence suggesting that an overwhelming majority of cervical cancer cases are preventable, it seems as though uptake of both main preventative measures in the UK is below where it needs to be. In 2022, 3 out of every 10 people who were eligible for a screening test in England actually attended their appointment and rates of HPV vaccination in Year 8 girls and boys were significantly lower than in 2021.??

So, what do we do about those screening and vaccination numbers? What is stopping people from attending their screening and consenting for their children to be vaccinated? How do we make these people change their minds? As those of you who are familiar with Caja’s work have hopefully noticed by now, these are questions that our clients ask us regularly.??

As with any behaviour, the answer is rarely straightforward and almost never the same for everyone. Yet, the more projects we deliver and the more localities we work across, the clearer the value of behavioural science becomes. Well, to us at least…?

Understanding Barriers: Frameworks such as the COM-B model of behaviour (Michie, van Stralen, & West, 2011) the Theoretical Domains Framework (TDF; Cane, O’Connor, & Michie, 2012), and the Theory of Planned Behaviour (TPB; Azjen, 1985) are essential to help change makers identify and understand what the key barriers to screening and vaccination might be. In our work, barriers we have identified range from being unable to understand technical language surrounding HPV to the misconception that being vaccinated means that there is no need for screening. By providing proven frameworks that guide questioning and analysis for insights activities, behavioural science can greatly enhance our appreciation of the conscious and unconscious factors that influence cervical cancer prevention behaviours.??

Changing Behaviours: Perhaps the key contribution of behavioural science to cervical cancer prevention is through the use of nudging to effectively influence population behaviours. We know that just being aware of a service and its associated benefits is rarely enough to encourage uptake. In fact, our insights work shows that awareness of the HPV vaccination and cervical screening is actually reasonably high. So, if education isn’t the answer, we need to use other methods to increase engagement in prevention programmes. At Caja, we support our clients in applying behavioural science techniques to design nudge interventions that can truly shift the dial. By understanding concepts such as Systems of Thinking, Cognitive Biases, and Values Modes, we can start to create interventions that directly target behavioural barriers to vaccination and screening, over and above merely educating people and trusting they then make the rational choice.??

Achieving Tangible Results:?

But don’t just take our word for it. Our application of behavioural science techniques to promote prevention behaviours has led to real tangible results, including:?

• Consistent increases in screening uptake by 25-50% in numerous locations across the UK with varying population demographics.?
• Increases in HPV vaccination uptake of up to 20% in some of the most deprived regions in the country.?
• Increases of screening uptake in traditionally “hard to reach” groups by up to 43% - directly tackling health inequalities.?
• Up to 32% increases in screening appointments amongst historical non-attenders. Equivalent to an extra 1000 screens per year across a typical Primary Care Network.??

Reading those results back makes us both proud of the work that we have done to date but also frustrated that this is not just the default approach to supporting the prevention of cervical cancer (and it seems these frustrations are shared). Earlier in January, we ran an Introduction to Behavioural Science workshop for a client and these sentiments were echoed by the workshop participants. We can take comfort in this, though. The fact that people who 4 hours earlier were completely oblivious to behavioural science as a concept where outwardly questioning why it isn’t “everywhere”, reassures us that the potential is there for all to see. This way of thinking can truly save lives and the more policy and change makers who realise this, the less people will needlessly die of an almost entirely avoidable illness. Where’s the downside to that??

To find out more about how we can help support cervical cancer prevention programmes, contact us directly at [email protected] or Tel: 01782 443020.????

References:?

Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions.?Implementation Science,?6(1), 1-12. https://doi.org/10.1186/1748-5908-6-42??

Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research.?Implementation Science,?7, 1-17. https://doi.org/10.1186/1748-5908-7-37??

Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In?Action control: From cognition to behavior?(pp. 11-39). Berlin, Heidelberg: Springer Berlin Heidelberg.?