“You don't have to be a survivor of abuse to be worried about smears”: Cervical screening experience of forensic inpatients

Purpose: Childhood trauma, especially sexual abuse is linked to higher health risks including cervical cancer. Forensic inpatients often have complex trauma histories placing them at increased risk of cervical cancer. The uptake of screening in patient forensic inpatient services is sub-optimal, although little is known about their experiences. This study focuses on the cervical screening experiences of people nursed in forensic service inpatients. This group present with unique health challenges and are an under-researched and vulnerable population with a higher risk of cervical cancer.Methods: A qualitative study used purposive sampling to recruit eight participants from two NHS secure forensic services. All participants were inpatients detained under the Mental Health Act (1983, revised 2007) in Women’s pathways. Data was collected through semi-structured interviews and was analysed using Interpretive Phenomenological Analysis.Results: Two superordinate themes were developed: (1) Internal Conflict linked past experiences to screening beliefs, and (2) Manufacturing Control showed how individuals employed strategies to feel psychological ready for screening.Conclusions: This study aimed to understand the facilitators and barriers to cervical screening among forensic in-patients and identify ways to improve their experiences to increase engagement in screening. The results identify how participants experiences prior to and within forensic services impact cervical screening uptake. Forensic inpatients require psychological readiness and feelings of control and safety to engage in cervical screening to minimise examinations reminding or re-enacting their trauma history. Systemic factors can enhance safety perceptions and encourage screening in this group.