Research Proposal: Women's Understanding of Cervical Cancer Screening

This research proposal outlines a descriptive qualitative study investigating women's understanding of cervical cancer and screening processes. The study aims to identify perceived barriers to screening participation, including psychological, emotional, and practical obstacles. The research will involve semi-structured interviews with 15 women to gather in-depth insights. The background highlights the incidence of cervical cancer in the UK, the importance of screening, and the role of HPV. The literature review synthesizes existing research on screening barriers, including lack of awareness, fear, shame, and cultural factors. The methodology includes database searches, inclusion/exclusion criteria, and critical appraisal of selected studies using SURE appraisal tools. The study seeks to address a research gap by focusing on the UK population and providing recommendations for interventions to improve screening rates and promote early detection and treatment, ultimately contributing to better health outcomes for women. The proposal emphasizes the preventable nature of cervical cancer through early screening and addresses the need to understand and overcome barriers to ensure women's well-being.

Running head: RESEARCH PROPOSAL
Research Proposal
Name of the Student
Name of the University
Author Note

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Research topic
Woman’s understanding of cervical cancer and screening: a descriptive qualitative study
Project layout or Summary
Cervical cancer occurs inthe cervical area of women. It is located in the lower part of
the uterus which connects to the vagina. Numerous strains of the human papillomavirus
(HPV), a sexually transmitted virus is the min causative agent of the cervical cancer.
According to the National Health Service [NHS] (2018), the best way to provide protection
from the cervical cancer is via attending the cervical screening test which is previously
referred as smear test. The NHS Cervical screening programme is open for the women
between the age group of the 25 to 64 years. Women between the age group of 25 to 49 years
are screened after every 3 years. Women aged between 50 to 64 years are screened after
every 5 years. According to Cancer Research UK (2018), 99.8% of cervical cancer cases are
preventable if early screening is undertaken. In UK there are 3,200 cases of cervical cancer
each year accounting to 9 new cases per day. Cancer Research UK (2018) stated that high
reported cases of cervical cancer in UK demonstrate that there is lack of proper screening of
the cervical cancer. Thus the aim of the study was to analyze the perceived barriers among
the women understanding of cervical cancer and screening process. In order to conduct the
study, the author will perform descriptive qualitative research with semi-structured open-
ended interview. Total of 15 respondents, will be recruited in the interview. The potential
outcome of the study will help the understand the principal psychological and other
underlying barriers among the women towards undertaking cervical screening process. The
analysis of the perceived barriers will help to frame interventions in order to improve the
overall screening of cervical cancer and this help in early detection and proper treatment of
the disease towards effective cure for better health and well-being.

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Background of the Study
According to the Cancer Research UK (2018), there are 3,200 cases of cervical cancer
in the UK each year. The incidence rate is higher among the women who are aged between
25 to 29 years, as highlighted during the census of 2013 to 2015 (Cancer Research UK 2018).
The women residing in the deprived areas of the England are the common victims. Among
the women, white females are accounts for more records in the cervical cancer in comparison
to the Asian females (Cancer Research UK 2018). A woman risk of developing cervical
cancer is modulated by different factors like age, genetic pre-disposition and exposure to
several other risk factors, which are potentially avoidable like lifestyle factors (Cancer
Research UK 2018). In the UK, cervical cancer is mainly caused by infection (99.8% of the
cases) and smoking (21% of the cases). According to the Cancer Research UK (2018) the
majority of the cases cervical cancers go unreported due to the fear or shame. More than 40%
of the women worry that their partner might feel that they are unfaithful. While others worry
that people might refuse of accept their social presence due to Human Papilloma Virus (HPV)
infection in their cervix. Another set of women think that being detected with cervical cancer
might eventually lead to death. These perceptions hamper the early screening process of
cervical cancer (Velindre NHS Trust Project 2017).
The sample for cervical cancer screening is collected via rotating an extended tip
spatula around the transformation zone, following the vagina. Cells are scraped from the
spatula over a slide, fixed and then sent to a laboratory for staining followed by manual
screening or automatic or semi-automatic screening (Velindre NHS Trust Project 2017). The
early detection of the cases of cervical cancer is followed by the tumour removal by surgery
or through the use of the radiotherapy or cancer therapy (Cancer Research UK 2018). In order
to understand the women understanding about the screening of the cervical cancer, a detailed
review of literature is important.

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Literature Review
A literature search was done in order to extrapolate the existing research into the
barriers of the early screening of the women with cervical cancer. The databases used for the
conduction of the literature search include CINAHL, Medline, Web of Science and
COCHRANE. The main keywords which were used for the search of the scientific articles in
the electronic databases are highlighted below in the table
Keywords Used For Database Search
1. Cervical Cancer Screening OR Screening of Cervical Cancer
AND
2. Women OR Female
AND
3. Barriers OR Problem
The search of the scientific articles was done with the use of the above mentioned
keywords. The authors also used Boolean Operators (AND/OR). According to Parahoo
(2014), the use of the Boolean operators helps to refine the search.(According to Aveyard
(2014), having a proper plan for conducting the search of the literary articles helps to retrieve
relevant research articles. Coughlan, Cronin and Ryan (2013)(et al)and Polit and Beck (2014)
further highlighted that proper plan for the conduction of the research deals with formulation
of the proper inclusion and the exclusion criteria of the research
It helps to filter out the irrelevant articles that falls outside the scope of the research
topic. The inclusion and the exclusion criteria that were used for the search of the literary
articles from the electronic database include
Inclusion Criteria Exclusion Criteria

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Time Frame: 2013 to 2018 Papers published before 2013
Language: English
Population: Women Between the age group of 18 to 65
years
Women below the 18 years and who
are above 65-year

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PRISMA Chart for the Search Results
Total of 3 studies were selected for the review of literature on the focus topic(the list
of the three selected articles is given in the appendix portion). The Specialist Unit for
Review Evidence (SURE) appraisal tool was used as a guide for the critical appraisal of the
selected articles (SURE 2013). SURE appraisal has separate set of questions for different
experimental study design. SURE tools for observational studies and experimental studies
were employed.
The aim of the research conducted by Marlow, Waller and Wardle (2015) was to
explore the self-perceived barriers to the attendance of the cervical screening among the
Records selected through database
searching (n = 216)
Studies included
(n= 3)
Records after the removal of duplicates (n=110)
Total records screened (n =
50)
Full text articles excluded with reasons
(n=15)
 Not as barriers from the women
point of view (n=8)
 Combination of psychological
barriers and backdrop in
technology (n=9)
Full-text articles assessed for eligibility
(n=20)
Records excluded based on title
screening (n= 60)Records excluded
based on abstractscreening(n=30)
Identification
Screening
Eligibility
Included
Medline (Ovid)
(n=49)
Scopus
(n=43)
Web of Science
(n=52)
Cochrane library
(n=72)

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ethnic minority women in comparison to the white British women. The qualitativeinterview
study was conducted over 43 women from ethnic minority background and 11 White British
women. The women were selected from seven different boroughs of London. The authors
obtained online list of the community against each Borough and respective group were
contacted either through emails or via telephone. Then random selection was done from the
willing group of participants. The interviews were recorded and then transcribed verbatim.
Framework analysis was done to analyze the data. The author undertook random-stratified
sampling for the sample recruitments. The results highlighted that the main barriers for the
ethnic minority women are lack of awareness about the cervical cancer, lack of proper
understanding about the term “cervical cancer screening” and “smear test”. Other barriers
highlighted include emotional barrier (shame, fear and embarrassment), practical barrier (lack
of adequate time) and cognitive barrier (low level of perceived symptoms and risk).
Emotional barrier are higher among the Asian women and low perceived risk of development
of the cervical cancer promoted sex with multiple partners. The limitation of the study is, the
authors failed to highlight why the choice of the qualitative study was appropriate for it.
However, sampling strategy used for the research is random stratified sample and the detailed
information of the demographic structure of the participants was elaborated in the tabular
format and this can can regarded as a strength of the study. Apart from the limitations
identified through the critical appraisal, the authors failed to highlight any limitations of the
research by themselves. The author also failed to highlight how the themes were generated
from the significant statement.
Akinlotan et al. (2017) analysed the cervical cancer screening barriers along with the
risk factor knowledge among the uninsured women through randomised control trial (RCT).
The authors conducted survey among 433 women. All of them had grant-funded
cervical cancer screenings during the tenure of 33 months. The inclusion of the women was

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done based on their family financial income (below 250% of the federal poverty level). The
analysis was of knowledge was done based on parameters like age, ethinicity, marital status,
race, education and employment status. The internal consistency of knowledge was measured
on the scale of 0 to 10.The descriptive statistical analysis highlighted significant co-relation
between knowledge of risk factors and educational attainment. The multivariate analyses
revealed in comparison to the Whites, Hispanic population have fear of getting detected with
cancer and thus refrain from attending screening. Apart from these, there are language
barriers and fear from the male physicians. The main strength of the study is its analysis
portion. The author collapsed the participants response under 5-point Likert scale and divided
it into three categories (1: disagree; 2: neutral; 3: agree). The authors also used Chi-square
test in measure the bivariant associations between the cervical cancer screening barriers and
the race.The use of proper statistical analysis results helped to researcher to fetch unbiased
data.However, the authors failed to mention that whether the selected group of population
was blinded about the scope of the research. Moreover, there are no specific indications
regarding whether the professionals who are used for the analysis of the results were also not
blinded. Conducting blinded trail is one of an important criterionof the RCT. If the reviewer
of RCT study is not blinded then it might give rise to observational bias originating from the
pre-conceived notion of the reviewer.
The study by William et al. (2013) was exploratory study in order to identify the
psychological barriers to cervical cancer screening among women in South Africa Ghana
with or out without cancer prognosis by the use of the mixed method approach. The semi-
structured interview was conducted with 49 Ghanaian women (suffering from cancer) and
171 Ghanaian women who did not had cancer. The authors used purposive sampling plan to
select the group of participants. The theoretical framework used to design this mixed method
study was based on the constructs from two domains of the PEN-3 model developed by

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Airhihenbuwa. This can be regarded as strength of the study. According to Iwelunmor,
Newsome and Airhihenbuwa (2014), PEN-3 cultural model helps to centralize culture within
the study of behaviors, health beliefs and health outcomes. The results of the quantitative
analysis highlighted that cancer patients are more likely to have higher knowledge about
cervical cancer in comparison to the women without cancer. The qualitative analysis by the
use of the statistics tool in order to review the survey results through Likert chart highlighted
that of the psychological perspective revealed that main hurdle towards cervical cancer
screening includes misconceptions, myths, cultural taboos and stigmatization.
Research gap
The analysis of the review of literature helped to identified several barriers which
delays screening process and this include lack of proper knowledge about the disease
symptoms, lack of proper awareness about the disease, social stigma, and lack of support
from the spouse, shame and fear from getting detected with the disease. However, the main
research gap is, lack studies conducted under the perspective of the UK population .
The majority of the study included population from Africa and China. One of the
selected studies though conducted under the UK perspective though highlighted the
psychological hurdle as a barrier behind the cervical cancer screening, but failed to state the
women’s understanding of the cervical cancer and other perceived social or economic
barriers for undergoing timely screening.

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Purpose of the Study
Thus the main purpose of the study is to analyse the understanding and the perceived
barriers among the women of UK about cervical cancer and cervical screening
Research objectives
1. Exploring the barriers to cervical cancer screening women living in the UK
2. To understand the level of knowledge and awareness of the women in UK about cervical
cancer
3. To frame proper recommendation for interventions in order to overcome the psychological
barriers
Research methods and design
Methodology: Descriptive Qualitative Study
In order to conduct the study, the author will use qualitative research approach. The
qualitative research will follow the conduction of the interview by the use of the semi-
structured interview The qualitative research approach was selected because the research
questions aim to explore the understanding of the experience of the women, their thought and
feeling in cervical cancer screening (Robb and Shellenbarger 2014). According to Davies and
Hughes (2014), qualitative research with semi-structured interview helps to understand the
underlying emotions or the thought process of an individual. The main research philosophy
that will be used for this research is interpretivism research philosophy. Interpretivsm
research philosophy assists the researcher to group diverse approaches and then amalgamate
those approaches into new emerging theory. This philosophy is opposed to positivism
research philosophy. Moreover, positivism research philosophy deals with the analysis of the

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statistical data, but interview questionnaire mostly deals with the collection and analysis of
the qualitative data (Bergh and Ketchen 2011). The interpretivism research philosophy will
help to identify the barriers affecting optimal screening of the cervical cancer among the
vulnerable group of population.The research approach that will be used for this qualitative
research is inductive research approach. Crowther and Lancaster (2012) stated that inductive
research approach assists in the generation of theories from the pre-existing source of
information. Research has selected inductive research approach over deductive research
approach because deductive research approach is based on the existing theories. The selection
of the inductive research approach will help the researcher to gather new set of information in
order to generate new theories guiding the psychological barriers of the cervical cancer
screening among the women. The research design that will be used in this qualitative research
is descriptive type research design. Ellis and Levy (2012) stated that descriptive type research
design helps the researcher to get a better understanding of a phenomenon based on an in-
depth study of the phenomenon.
Sampling
Women will be recruited with the help of the purposive sampling plan. Under this
purposive sampling plan, women who have attended or availed the service at the colnoscopy
department in a state run hospital in the UK (Hospital X: name withheld) will be approached
to take part in the interview process. The patients’ availed service during the last 6 months
will be approached. No specific bar will be given to the age group of participants. All adult
women (19-65 years) will be eligible for the study irrespective of their financial and social
status. Recruiting women from a large age group will help to get an overview of the
perception of the women about the cervical cancer screening irrespective of their age limit.
Minimum educational qualifications that will be selected for the participant recruitment will
be high school qualified. Having a minimum educational qualification will help the

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participants to understand the questions of the interview and article their feeling in an
appropriate manner. Participants with excellent to moderate English proficiency will be given
preference as the questions of the interview will be framed in English. A mail will be
communicated to the participants to their official mail Ids and the interested candidates who
will reply back will be approached through phone. The selection of the final 15 participants
from the main sample pool (the women who have replied back in the consent mail) will be
done randomly. The reply mail of each of the participants will be given an ID number
(unique identification code) among those code 15 codes will be selected randomly in order
ensure randomisation and to avoid selection bias. According to Bergh and Ketchen (2011),
sampling done through purposive sample plan help the researcher to have a concrete
framework for sampling technique helping to execute in an ordered manner.
Inclusion criteria women (sample size: 20)
1. Age group: Adults (18-65 years)
2. Active sex life
4. Cancer status: NA
5. Well to moderate proficiency in English
6. Minimum qualification: High school
Data collection
Interviews will be conducted in respective home of the participants in order to ensure
the ease of participation, familiarity and comfort along with privacy and confidentiality. An
alternative yet accessible community venue will also be used if the selected groups of
participants refuse to participate in the interview process at their own residence. The
interview will be semistructured and will be done with use of the 10 open-ended
questionnaires covering the key areas of the screening of the cervical cancer. According to

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Quinn and Clare (2008), the conduction of the semi-structured interview ensures that all the
principal areas of the research are covered and at the same time, it allows the researcher the
flexibility to pursue other interesting topics that might arise during the time of the interview.
The schedule of the interview will be fixed as per the convenience and the drafting of the
questions will be done based on the psychological and social areas highlighted from the
review of the literature. It is anticipated that the interview will last for 45 to 60 minutes. The
interview will be recorded through audio recorded in order to allow transcription verbatim
once it is completed.
The interview will explore the women’s understanding of cervical cancer and barriers
they experience while undertaking screening.
Data analysis
Once the interview is completed and is recorded in the audio-recorded, the recorded
interview will be transcribed. The generated transcript will be read and re-read several times
in order to allow immersion of the researcher in the data. Qualitative data-analysis will be
done by the generation of the themes from the interview transcript. Thematic analysis will be
done in order to recognise and to study the pattern of the data both within each interview and
then across the interview. This will be done in a comparative manner in order to aid
interpretation of the findings (Braun and Clarke 2006).
Ethical governance
According to the rules and the regulation of the Cardiff University, it is the
responsibility of the researchers to ensure that their research is conducted under the highest
levels of ethical standards. It is the duty of the researchers to ensure that they are complying
with all the University’s expectations in the domain of ethical conduct of research and the
ethical requirements of the research funders, other professional bodies of research and/or the

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standard expectations of their research discipline. Based on the university guidelines, the
ethical considerations that will be strictly followed in this research are highlighted below with
detailed justification.
In the ethical governance, according to the Data Protection Act, proper protection of the
confidentiality and privacy of the participants will be given. Before the initiation of the
interview process, the participants will be asked to sign the consent form. Inside the consent
form, there will be detailed illustrations of the scope and the purpose of the research. This is
known as participants information leaflet.The consent form will also highlight that
conduction of the interview process will be taken as per convenience of respondents and they
can leave the interview process at any point time without any prior notice. None of the
participants will be forced for the interview as this will lead to breaching of the ethical
principle of autonomy (Merriam and Tisdell 2015). The interview questions will be free from
any derogatory questions or questions related to cultural or religious beliefs that might harm
the sentiments or spiritual thoughts of the respondents. This will help to ensure “non-
malfeasance” that corner for no harm being brought to the participants. Moreover, if any of
the participants feel uncomfortable in answering any of the questions present in the
interview then none of them will be forced to answer those questions.
Moreover, in order to ensure the privacy and the confidentiality of the patient’s personal
information, the name and other personal details of the participants will be kept confidential.
The computer containing the respondents data will be password protected (Research Integrity
and Governance Code or Practice (Cardiff University). The consent form containing the
name of the respondents and their address will be kept secured in the locker of the author and
no one will be allowed to access that data other the author and the co-author. During
recording of the interview each participants will be given a pseudo name and unique
identification number and the same code will be used while the generation of the transcript

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and research conduction. This will ensure anonymity of the participants (Merriam and Tisdell
2015).The person who is making the written transcript of the interview will not be allowed to
view the names of the participants. The general description of the participants along with the
other identification details will also be kept confidential this will further help to stringent the
confidentiality and privacy of the research.
The ethical approval for the research will be obtained from the Cardiff University.
The research will strictly adhere to the Integrity of Practice as documented by the Cardiff
University.

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References
Akinlotan, M., Bolin, J.N., Helduser, J., Ojinnaka, C., Lichorad, A. and McClellan, D.,
(2017). Cervical cancer screening barriers and risk factor knowledge among uninsured
women. Journal of community health, 42(4), pp.770-778.
Aveyard, H., (2014). Doing a literature review in health and social care: A practical guide.
McGraw-Hill Education (UK).NewYork
Barbour, R. (2014) Introducing qualitative research: A student’s guide. 2nd ed. London:
SAGE Publications Ltd. London
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1st ed. Bingley: Emerald Group Publishing Ltd. Bristol
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statistics-by-cancer-type/cervical-cancer#heading-Zero
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and Social Care: SAGE Publications. Sage.
Crawford A, Benard V, King J, Thomas CC (2016). Understanding Barriers to Cervical
Cancer Screening in Women With Access to Care, Behavioral Risk Factor Surveillance

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System, 2014. Preventing Chronic Disease: Centre for Disease Control and Prevention;
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Marlow, L.A., Waller, J. and Wardle, J., (2015). Barriers to cervical cancer screening among
ethnic minority women: a qualitative study. Journal of Family Planning Reproductive Health
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Merriam, S.B. and Tisdell, E.J., (2015). Qualitative research: A guide to design and
implementation. John Wiley & Sons.London

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National Health Service. (2018). Screening for cervical cancer. Access date: 11th December
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William, M., Kuffour, G., Ekuadzi, E., Yeboah, M., ElDuah, M. and Tuffour, P., (2013).
Assessment of psychological barriers to cervical cancer screening among women in Kumasi,
Ghana using a mixed methods approach. African health sciences, 13(4), pp.1054-1061.

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Appendix
List of the Select Articles for the Critical Review
Name of the
Authors
Year of
Publicati
ons
Name of the Paper Name of the
Journal
Volume
and
Page
Marlow, L.A.,
Waller, J. and
Wardle, J.,
2015 Barriers to cervical cancer screening
among ethnic minority women: a
qualitative study
J
FamPlannRepro
d Health Care
2014-
101082
Akinlotan, M.,
Bolin, J.N.,
Helduser, J.,
Ojinnaka, C.,
Lichorad, A. and
McClellan, D
2017 Cervical cancer screening barriers
and risk factor knowledge among
uninsured women
Journal of
community health
42(4),
pp.770-
778
William, M.,
Kuffour, G.,
Ekuadzi, E.,
Yeboah, M.,
ElDuah, M. and
Tuffour, P.
2013 Assessment of psychological barriers
to cervical cancer screening among
women in Kumasi, Ghana using a
mixed methods approach
African health
sciences
13(4),
pp.1054-
1061