Untimely follow-up after cervical cancer screening: A qualitative study among healthcare providers in Flanders (Belgium)
- 1Department of Health Promotion, CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- 2Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- 3Department of Health Promotion, NUTRIM, Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
Abstract
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.
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BibTeX
@article{hendrickx2026untimely,
title = {{Untimely follow-up after cervical cancer screening: A qualitative study among healthcare providers in Flanders (Belgium)}},
author = {Marie Hendrickx and Laure-Anne Kerckhaert and Sara Willems and Rik Crutzen and Vera Verbestel and Katrien Vanthomme},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359860},
url = {https://doi.org/10.1371/journal.pone.0359860},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Untimely follow-up after cervical cancer screening: A qualitative study among healthcare providers in Flanders (Belgium)
AU - Marie Hendrickx
AU - Laure-Anne Kerckhaert
AU - Sara Willems
AU - Rik Crutzen
AU - Vera Verbestel
AU - Katrien Vanthomme
PY - 2026
DA - 2026/10/07
JO - PLOS One
DO - 10.1371/journal.pone.0359860
UR - https://doi.org/10.1371/journal.pone.0359860
AB - 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.
SN - 1932-6203
ER -