New research from the University of Aberdeen and the Grampian Regional Equality Council (GREC) has outlined ways to make cancer screening services more accessible to people who may be 'under-served' by the healthcare system.
The project was funded by NHS Grampian and is published in Cancer Medicine.
Cancer screening, such as cervical smear tests, mammograms and bowel screening is available to everyone registered with an NHS health board. These tests help detect cancer at an early stage when treatment is most likely to be successful. However, the authors report that, within the Grampian region, uptake of screening tests is markedly lower among people living in more deprived areas and among some ethnic minority communities, particularly those from Polish and African backgrounds.
Working directly with communities in Grampian, the team explored the reasons behind the low uptake and identified practical changes that could make screening more accessible and acceptable. Some of these recommendations are already being put into practice in the region and have also featured in Cancer Research UK’s national guidance for professionals supporting breast cancer screening.
Their findings recommend more ‘community-informed’ and ‘culturally tailored’ approaches to cancer screening. Changes already adopted include working with local women’s groups to build trust, training community volunteers to share information and support decision-making, developing clear and culturally appropriate communication materials, and identifying key points in the screening process where additional support can make a difference.
Dr Sarah Prowse, Research Fellow, who led the study at the University of Aberdeen explains: “Cancer screening helps to detect disease early, when it is more treatable. However, not everyone in the Grampian region has equal access to this benefit. People from African and Eastern European communities, and those living in more deprived areas, are less likely to attend screening and may face barriers that are not fully recognised or addressed by existing services.
“This work helps to shine a light on those gaps. By listening to communities directly and working in partnership with organisations like GREC, it becomes possible to identify what needs to change. This includes how information is shared, who delivers it, and how trust is built. Without this kind of insight, inequalities in outcomes are likely to continue.
“The next stage of this work is focused on building momentum and ensuring that the changes already underway can be sustained and adapted over time. This includes continuing to work in partnership with communities, expanding approaches that show promise, and creating space to test new ideas based on ongoing feedback.
“It is encouraging to already see our findings highlighted in the recent Scottish Government review on ethnic and racialised inequalities in cancer services, helping to inform the next Cancer Action Plan.”
Adriana Uribe, Training Consultant and Language and Integration Team Lead from the Grampian Regional Equality Council said: “Cultural awareness is an essential first step to ensure that health programmes can reach out communities that may otherwise be excluded. During this study, participants offered very valuable input about their engagement with services, highlighting the need to adopt a multicultural approach and consider the difficulties many face as a result of language and social barriers.
“This approach to minority communities shed light on their perspective about health screening programmes and how future approaches could improve to ensure effective engagement. Health is important for everyone, but cultural understanding is essential to achieve engagement to advance health prevention.
“This project demonstrates that inclusion is not only possible, but also extremely useful to ensure that health screening and future prevention are accessible to everyone. When communities are heard, the opportunities to gain valuable understanding multiply and can inform more effective approaches.”
Professor Shantini Paranjothi, Director of Public Health, NHS Grampian and Honorary Clinical Chair at the University of Aberdeen added: "The partnership with the University of Aberdeen and the Grampian Regional Equality Council (GREC) has helped us rethink how we can support people to take part in screening programmes in Grampian. By taking an evidence-based approach informed by lived experience, we can target our interventions more effectively. This has helped us to develop culturally appropriate communication materials and training programmes to support staff and community members to have informed conversations regarding screening.
“The way we work day-to-day to promote screening has changed, with a shift towards more two-way, community-informed communication. Through our work with community champions, we have seen how culturally aware outreach and ongoing feedback from underserved groups can strengthen trust and make screening information more meaningful and accessible. This approach is helping us build services that feel more responsive to people’s real experiences and better equipped to support equitable access across our communities.”
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