Abstract / Summary
Background: Cervical cancer remains a global health burden despite being largely preventable through vaccination, screening, and timely treatment. Delays in follow-up after abnormal screening undermine the effectiveness of organized cervical cancer screening programmes. In Flanders (Belgium), organized screening and reminder systems exist, yet 17.7% of women do not receive adequate follow-up after an abnormal Pap smear, highlighting the need to understand multilevel factors influencing timely follow-up.
Methods: Between September and November 2025, 14 semi-structured group interviews were conducted in person with 120 general practitioners and gynaecologists responsible for cervical cancer screening in Flanders. Interviews were audio-recorded, transcribed verbatim, and analysed in MaxQDA, using iterative thematic analysis combining deductive multilevel framework coding with inductive insights. Interviews were double-coded, with discrepancies resolved through discussion. Data collection and analysis proceeded concurrently until saturation and findings were validated with stakeholders.
Results: Despite the organized screening programme, healthcare providers experience cervical cancer screening follow-up as a complex, fragmented, and non-standardized multi-step pathway. Delays were mainly attributed to provider- and system-level factors, including inconsistent communication, challenges in interdisciplinary responsibilities and collaboration, high workload, and poorly integrated digital systems. Patient-related factors, such as language barriers and health literacy played a secondary role. Current follow-up processes were described as relying heavily on individual provider initiative rather than on well-coordinated, system-level structures. To improve timely follow-up, healthcare providers recommended standardised and proactive communication, clearer task allocation and responsibility, better integrated digital systems, the optimisation of the existing reminder mechanism and enhanced patient education.
Conclusion: Delays in follow-up primarily reflect organisational and system-level weaknesses. Standardization, integrated digital systems, and clarified roles and responsibilities are key to reducing preventable delays. A "double safety net" combining provider oversight with informed patient involvement, alongside greater primary care engagement, may further enhance the continuity and timeliness of follow-up care.