Table 4 How key issues from stakeholder focus groups converted into action points in the animation script

1. Identify and communicate with non-attenders who are over 50.

• Link cervical screening with chronic illness reviews, carer reviews, etc.

• Ring non-attenders directly about screening: listen, inform, explain.

• Have regular practice meetings raising patients’ individual issues.

• Raise awareness, address myths and misunderstandings.

Introduction: Professional expert on women’s health (General Practice) describes why and how the intervention has been put together.

Central section: A conversation between two women over 50, voiced by actors, illustrates the challenges that cervical screening practitioners may face with this cohort. The dialogue follows a timeline of screening-related experiences from women’s twenties into their sixties, through the decades. Phrases drawn from the qualitative interview data are woven into the dialogue to illustrate the barriers and facilitators of attendance. The narrative explores:

• misunderstandings surrounding the screening test;

• different attitudes towards risk;

• how experiences of intimate examinations in previous decades can affect attitudes towards screening;

• how sex/relationship issues affect attitudes to screening;

• how problems related to menopause and chronic illness can affect practical aspects of the screening test.

Close: The women’s health expert summarises the key issues and states a three-point call to action:

• Prepare: Address physical and psychological issues, build a network of professional support to develop your expertise.

• Listen: Take patient history, build rapport, address psychological and physical challenges.

• Adapt: Where possible and practical, take a flexible approach to appointment booking, and to screening procedures (e.g. positioning).

2. Make appointments flexible in a way which encourages attendance in older women

• Offer repeat appointments over time rather than one-off appointment.

• Offer extended hours (dependent on capacity).

• Offer screening opportunistically.

• Network with other screen-takers in your GP practice.

• Allow your patients to choose their screening practitioner.

3. Develop rapport with older women attending for screening.

• Inform patients about how screening procedures have changed.

• Proactively ask women why they do not attend.

• Talk through the procedure, inform women in personal manner.

• Encourage collaboration between older and younger practice nurses to talk through age-related issues.

• GPs to be made aware of reasons for appointments in advance.

4. Tailor the screening process to take older women’s needs into account.

• Discuss and address sexual difficulties caused by menopause and/or chronic illness.

• Have all tools ready in advance, do not leave the room, actively problem solve environmental issues (e.g. broken door locks) in a timely manner.

• Make plastic speculums standard.

• Learn to ‘size’ women for appropriate speculum as they enter the room.

• Allow women to insert speculum themselves.

• Practice different positioning for older women to take account of mobility problems.

• Have senior screening staff in attendance to offer practical advice.

• Invest in rapport-building with colposcopy units to draw on expertise where screening is difficult.