Who is left out? A systematic review on the barriers and facilitators for screening participation reported by people in vulnerable situations with strategies for the future.

OBJECTIVES

This review aims to give a comprehensive overview of barriers and facilitators reported by people in vulnerable situations (PiVS) for screening participation. Furthermore, it investigates proposed strategies to increase screening participation, as reported in quantitative and qualitative empirical studies.

STUDY

DESIGN

Systematic review.

METHODS

The databases Embase, CINHAL, PsycINFO, Web of Science and PubMed including Medline were systematically searched for papers (from January 2013 to June 2023) on barriers and facilitators experienced by PiVS on participating in screening programmes on chronic diseases of high-income countries. The included papers were analysed thematically.

RESULTS

96 papers were included. Results show barriers and facilitators mostly related to health literacy e.g. lack of resources, feelings of anxiety e.g. regarding test outcomes, and feelings of doubt e.g. regarding Western healthcare practices. Factors influencing screening participation can act both as barriers and facilitators. Studies suggested education, community-based interventions and support from healthcare providers as strategies to increase screening participation. The results show a focus on ethnic minorities as study populations. These populations reported mainly socio-cultural barriers and facilitators, such as religious beliefs. Consequently, there is limited representation of people in diverse vulnerable situations.

CONCLUSIONS

This paper represents the voices of PiVS by showing barriers and facilitators reported by themselves. Currently, there is limited representation of diverse vulnerable groups and limited insight into how barriers and facilitators play out in people's daily lives. Therefore, we propose for future research to study the everyday-life to gain in-depth insight into the intersection of barriers and facilitators and how they influence decision-making. We propose for future screening developers to use participatory practices to build upon the experiences of diverse PiVS in order to develop and implement more inclusive screening programmes.