Co-designing solutions to promote awareness of cervical screening with women of low socio-economic position living in urban areas

Women of lower socio-economic position have a higher incidence of cervical cancer and less awareness and lower uptake of cervical screening in Ireland. Co-design is an approach applied in health research that works with healthcare professionals, patients and service-users to collaboratively develop solutions to a problem they face, valuing their expertise and knowledge. This research aimed to co-design appropriate solutions to promote cervical screening among women of low socio-economic position. Women aged 25–65, living in Dublin, who self-reported regular or irregular screening attendance, without university-level education and in low-income employment or not working, were recruited via community organisations. A pragmatic theory-informed co-design approach was employed using the Double Diamond design framework and behaviour change theory. Four co-design workshops were conducted to ideate solutions to overcome the barriers to screening participation and prototype solutions to promote screening using liberating structures, techniques and participatory activities. Subsequently, focus groups and interviews were conducted with other women of low socioeconomic position, healthcare providers, policymakers and community workers to assess their perceptions and acceptability of the co-designed solutions. The co-design group (N = 8) prioritised the following enablers and barriers to screening: visibility in the community; emotions of fear and anxiety; and support of friends and family. After ideating potential solutions, the top considerations were: supportive and accompanying friends/family; a national awareness day; education as early as possible. The co-design group prototyped two solutions: (1) a screening promotion tag placed alongside the price tag on underwear in clothes shops; and (2) a coffee morning in a local setting with a nurse to provide information on screening. Both solutions were perceived as acceptable to a range of stakeholders (N = 18) who suggested amendments to enhance the co-designed outputs. The co-designed solutions to develop campaigns to increase visibility in their community and normalise conversations about screening were acceptable. Community-led educational interventions and impactful marketing campaigns hold promise to increase awareness of screening. The study delineates genuine co-design research where women were decision-makers in developing relevant interventions to promote cervical screening in their community. This study provides a transparent, novel, theory-informed framework for co-designing health interventions.