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Access and barriers to cervical cancer screening among middle-aged women living with disabilities in Japan and the United Kingdom: multidisciplinary research using a social innovation approach - NU/LSHTM project

Supervisors

LSHTM

Nagasaki University

Adviser

Project

Sexual and reproductive health is crucial to basic well-being and physical and mental health throughout the lifetime, and the World Health Organisation (WHO) states that this right should be respected and protected regardless of age or ability.1 However, sexual and reproductive health programs have focused on young people and middle-aged people have been largely neglected. Persistent social misconceptions and stigma that middle-aged and disabled people are asexual exacerbate the problem.2

Women with disabilities have a higher risk of invasive cervical cancer compared to other women.3 However, LSHTM research has demonstrated women with disabilities are 33% less likely to be screened for cervical cancer than women without disabilities4.   Both the UK and Japan have large number of middle-aged women who do not receive cervical cancer screening, despite having universal healthcare systems that should theoretically provide access to all, including those with disabilities. 

From a public health perspective, this gap highlights the need to focus on middle-aged disabled women who have been excluded and face with disparities in cervical screening.  While the UK's sexual health services remain largely centralized through the NHS, there are ongoing discussions about potential decentralization. In contrast, Japan has already incorporated some decentralized elements in its healthcare system, with screening often organised at the municipal level. This difference in approaches offers a unique opportunity to compare these systems and address disparities in cervical screening access at the different implementation stages. 

This project aims to conduct a cross-country mixed-methods comparison of the current situation cervical cancer screening access and utilisation among middle-aged women with disability in Japan and the UK. Through this comparative analysis, we contribute to identify best practices, challenges, and potential strategies that can inform policy and practice not only in these two countries but also in other high-income nations grappling with similar public health challenges.

The study, in particular, will investigate the current challenges and strategies to improve their access to cervical cancer screening. The main objectives of the study are as follows: 

  1. Identify barriers and facilitators of access to cervical cancer screening among middle-aged disabled women using qualitative interviews and identify potential strategies to address those issues by utilising participatory approaches 
  2. Develop policy recommendations to decentralize cervical cancer screening for women with disabilities in high-income country settings. 

It is envisioned that the PhD candidate will complete the following activities:

  1. To identify barriers and facilitators of cervical cancer screening among middle-aged women in the UK and Japan (semi-structured interviews, crowdsourcing open call).
  2. To develop policy recommendations for high-income country settings based on research findings, in Japan and the UK where has/is trying to implement decentralised cervical cancer screening system, through a designathon with policymakers (local council, consultants, NGOs, INGOs, charity bodies), health professionals, experts in disability research and middle-aged women living with disabilities. Given the limited existing data in both countries, our findings are expected to help inform the service end users, policymakers and health professionals. 

References

  1. World Health Organization (2024) Sexual health. WHO. Retrieved August 16, 2024.
  2. Craig, L. E., Chen, Z. E., & Barrie, J. (2022). Disability, sexual and reproductive health: a scoping review of healthcare professionals' views on their confidence and competence in care provision. BMJ sexual & reproductive health, 48(1), 7–15. https://doi.org/10.1136/bmjsrh-2020-200967
  3. Hu, K., Wang, J., Sparén, P., Herweijer, E., Sjölander, A., Adami, H. O., Valdimarsdóttir, U., Sundström, K., & Fang, F. (2023). Invasive cervical cancer, precancerous lesions, and cervical screening participation among women with mental illness in Sweden: a population-based observational study. The Lancet. Public health, 8(4), e266–e275. https://doi.org/10.1016/S2468-2667(23)00026-9
  4. Andiwijaya, F. R., Davey, C., Bessame, K., Ndong, A., & Kuper, H. (2022). Disability and Participation in Breast and Cervical Cancer Screening: A Systematic Review and Meta-Analysis. International journal of environmental research and public health, 19(15), 9465. https://doi.org/10.3390/ijerph19159465

The role of LSHTM and NU in this collaborative project

It is expected that successful applicants should have a Master’s degree in the field of Epidemiology, Public Health or a related discipline.  

Essential criteria:

  1. Background or interest in the field of sexual and reproductive health and working within the interdisciplinary research team.
  2. Qualitative research skills (NVivo or similar).
  3. Experience with participatory research approaches, such as crowdsourcing, co-creation, and co-development.
  4. Ability to communicate effectively in spoken and written English and in Japanese since the project will involve participatory activities in both languages.  

The project is well-suited for students with a background in social science, and public health. 

Skills we expect a student to develop/acquire whilst pursuing this project

  • In-depth understanding and experience of sexual and reproductive health research in the UK and Japan.
  • Proficiency in using participatory methods (crowdsourcing open call, and designathon) in social science fields. 
  • Data analysis skills (qualitative data).
  • Project management skills.