Research

Evaluation of an audit and feedback intervention to improve uptake of cervical screening

Erica di Martino, Tasneem Khan, Stephen H Bradley, Tom Daniels, Robbie Foy, Sarah Alderson, Richard D Neal and Thomas A Willis
BJGP Open 6 October 2026; BJGPO.2025.0218. DOI: https://doi.org/10.3399/BJGPO.2025.0218

Abstract

Background Cervical screening programmes are long-established and supported by robust evidence, but participation is declining. Around a third of those eligible did not participate in England in 2023–2024.

Aim To evaluate the feasibility and acceptability of an audit and feedback intervention to improve the uptake of cervical screening in general practice.

Design & setting Semi-structured interview study with general practice staff in three primary care networks (PCNs) and regional and national policy leaders.

Method Quarterly reports were generated for 23 general practices comparing cervical screening coverage with other local practices with similar population levels of deprivation, alongside resources and practical suggestions to improve screening uptake. Reports were emailed to practice managers who were asked to share them with their teams. The authors conducted semi-structured interviews with practice staff and health service leaders to determine how the reports were received, understood, and used. Interviews were structured and analysed using Clinical Performance Feedback Intervention Theory (CP-FIT).

Results Fourteen practice staff and three service leaders were interviewed. Practice teams seldom recalled seeing the feedback reports before interview invitations but generally viewed them positively when shown at interview. Report format, length, frequency, and content were considered appropriate. Staff involved in cervical screening found the reports clear and informative, and thought that enhanced awareness and motivation could prompt positive actions.

Conclusion Audit and feedback cannot improve cervical cancer screening uptake if targeted recipients do not receive it. More effective methods are required to engage or circumvent practice ‘gatekeepers’ to ensure feedback reaches those it is intended for.

How this fits in

Cervical screening is a long-established, life-saving intervention which is open to women aged 25–64 years in the UK NHS. It is administered via general practices, but participation is declining. Audit and feedback has previously been demonstrated to improve patient care in general practice but evidence for its impact on the uptake of cervical screening is limited. This evaluation found that an audit and feedback intervention was acceptable and perceived positively but requires more active dissemination to ensure it reaches targeted recipients, and support for practice staff to plan and implement improvement.

Introduction

Cervical cancer is only the fourteenth most common non-skin cancer among women in the UK. With its incidence falling by 24% since the 1990s, the disease now accounts for less than 1% of cancer deaths.1 However, cervical cancer warrants particular attention because, unusually among cancers, the disease is highly preventable through vaccination and screening. Since comprehensive access to these interventions could prevent around 350 000 deaths globally per year, the World Health Organization (WHO) has declared that health services should aim to achieve the ‘elimination’ of cervical cancer (defined as four or fewer new cases per 100 000 women annually).2

In the UK, vaccination against human papillomavirus (HPV; which covers the strains causing most cases of cervical cancer) has been offered to 12- and 13-year-old girls since 2008;3 as of 2025, the oldest vaccination cohort remains under 30 years old. Therefore, most women remain unvaccinated and at risk, including those aged 30–34 years who have the highest incidence of the disease.4 Moreover, in England, less than 75% of eligible girls receive vaccination and important inequalities persist, with those from minority ethnic communities or with mental illness less likely to be vaccinated.3,5–7

Despite the need for ongoing cervical screening, participation rates have fallen.8,9 In England, only 69% of those eligible were screened in 2023–2024,10 a 10-percentage point fall from 2008–200911 and far below the 80% target.12 Women in the most deprived quintile of the Index of Multiple Deprivation aged 25–49 and 50–64 years have uptakes of 8% and 11% less than the most affluent quintiles, respectively.13 Uptake is also lower in areas with higher proportions of minority ethnic populations.14

In England, cervical screening is administered by general practices and delivery is incentivised through the Quality and Outcomes Framework (QOF), a remuneration scheme based on performance.15 The extent to which this motivates teams to improve uptake is unclear. Audit and feedback is an established quality improvement method,16 comprising a review of performance against explicit standards (audit) followed by the presentation of data (feedback). A Cochrane review of 292 randomised trials found that this relatively low-cost intervention produced a mean absolute increase in desired practice of 6.2%.17 This can translate into meaningful population-level impacts.18

One review of interventions to increase uptake of screening for breast, cervical, and colorectal cancers identified audit and feedback as a ‘recommended’ tool.19 Another review found it was the only intervention which improved screening uptake across both single- and multi-component intervention studies in primary care.20 Evidence is more limited for cervical screening alone21 but positive effects have been shown outside of UK primary care.22–24

The authors evaluated the acceptability of an audit and feedback intervention targeting cervical screening uptake and explored the feasibility of a wider rollout.

Method

Design

The authors conducted a semi-structured, theory-guided interview study. They followed COnsolidated criteria for REporting Qualitative research (COREQ)25 and Template for Intervention Description and Replication (TIDieR)26 reporting guidance (Boxes S1 and S2).

Feedback intervention

The CervicAl SCreening AuDit and feedback Evaluation (CASCADE) was piloted in three primary care networks (PCNs: grouped general practices working together to deliver integrated care to their local population) in Leeds, UK, between October 2023 and July 2024. This equated to 23 practices, with a total patient population of approximately 144 000.

Feedback reports were emailed (Supplementary Figure S1) to managers of participating practices at quarterly intervals, with a request that they be shared with practice staff. Each practice received feedback up to four times during the pilot. Feedback design and content drew on literature on effective feedback,27 incorporated behaviour change techniques,28 and were based on interventions previously demonstrated as effective at targeting other clinical practices in this setting.18,29 Practice screening data were extracted from the Open Exeter platform via NHS Digital: a system that collated cervical screening data for all practices in England. It has since been replaced by the NHS Cervical Screening Management System (https://cervicalscreening.nhs.uk). At the time of the study, women aged 25–49 years were invited for screening every 3 years and those aged 50–64 years were invited every 5 years. Screening intervals for younger women who test negative for HPV and are at low risk of cervical cancer have since been revised to every 5 years.30 For feedback reports, screening coverage was calculated as women screened in the previous 42 months for women aged 25–49 years and 66 months for women aged 50–64 years (that is, allowing up to 6 months overdue) divided by the number of eligible women on the last day of the review period. At the time of report dissemination, data were 4 months old for the first round and 3 months old for the remaining three rounds. Graphs presented performance relative to: a) other practices in their PCN (an example of benchmarking) and for the same period the previous year (trend); b) other Leeds practices within the same deprivation quintile; c) all Leeds practices. Links to resources and further support were provided.

Sampling and recruitment

All staff members with responsibilities for cervical cancer screening (for example, practice managers, GPs, nurses) in the 23 practices that participated in the feedback intervention were eligible for interview. Invitations to interview were emailed to the managers of all participating practices and they were asked to circulate them among their teams.

SHB identified and invited participants who had roles in regional health system leadership and national policy with respect to cancer screening via his established contacts as a clinical lead for cancer in an integrated care board. All participants were offered £50 reimbursement for interviews.

Theoretical framework: Clinical Performance Feedback Intervention Theory

Clinical Performance Feedback Intervention Theory (CP-FIT)31 explains how clinical feedback may work and discusses influences on its effectiveness. The theory includes the feedback cycle: goals are established and performance audited, and then feedback messages are communicated to appropriate health professionals, who must interact with and accept the report to stimulate intentions and appropriate actions to bring about individual or organisational change and, ultimately, improved care quality. Factors relating to the feedback, recipient, and context will all influence cycle progression, which will be restricted, or halted, if an individual cycle component is not achieved. The authors have previously used CP-FIT to explore the impact of national clinical audit programmes.32 In this study, CP-FIT was used to structure interviews (Table 1).

View this table:
Table 1. The Clinical Performance Feedback Intervention Theory (CP-FIT) feedback cycle components and associated interview questions

Procedure

Interviews were completed from April–June 2024 by EdM and TW. They were conducted remotely (using MS Teams) and lasted approximately 30 minutes. At least two reports had been sent to all practices by this time; interviewees were provided with a copy of a report to aid discussion. Open-ended questions were asked about the feedback before progressing to questions structured around the CP-FIT feedback cycle. Field notes were made immediately after interview. Audio recordings were transcribed verbatim and anonymised.

Analysis

A structured, deductive content analysis was conducted that drew on rapid qualitative techniques.33,34 Using the CP-FIT feedback cycle as a framework, data were deductively coded to cycle components to indicate participants’ views about how each component applied to the intervention. The coding sheet contained space for recording additional issues that emerged inductively and were not related to cycle components. To ensure reliability, EdM and TW independently coded four transcripts and checked whether data were coded to the same cycle components. Differences were resolved by discussion. Remaining transcripts were divided between EdM and TW with regular checks of agreement. Following coding, a matrix was created which was populated with summaries of participant comments that mapped to each cycle component. The matrix was divided into two sections, the first covering ‘positive’ comments (i.e. where the component appeared to have been achieved) and the second on potential breaks in the cycle. Data were managed using Microsoft Excel.

Data were analysed in relation to all cycle components. However, to permit greater focus upon the findings that participants emphasised as the most important, the authors selected specific cycle components for presentation here (the remainder are in Supplementary Box S3). All authors contributed to this decision process. Tables S1–S10 provide additional quotes associated with all components.

Results

Of 17 interviews, 14 were with practice staff – the intended feedback recipients – and three with individuals with roles in commissioning and promoting cancer screening (Table 2). Eight of the 23 practices receiving feedback were represented in the sample.

View this table:
Table 2. Distribution of participants by professional role

Goal setting (feedback cycle component 1)

All interviewees considered cervical screening to be of clinical and public health importance, felt that the clinical standard targeted by feedback (i.e. the proportion of eligible patients screened during a specific timeframe) was clear, and recognised that increasing uptake would be desirable.

‘Cervical cancer used to be the biggest killer of women and now it’s not. And I think what’s been done, it’s such a successful screening programme, I am quite passionate about it.’ [P10, Nurse]

Practice staff confirmed that the goal of increasing uptake was within their teams’ control. However, the management and delivery of screening, and consequently the perceived relevance of the intervention, varied with specific staff roles. GPs supported the feedback but some explained that nursing staff were responsible for cervical screening and therefore felt that feedback should be directed to them. This position was endorsed by some nurses, suggesting that regular feedback of this nature should be targeted more precisely:

‘I’m not the person with like the overall responsibility for cervical screening in our practice. I think obviously it’s more useful to the practice nurse who has that responsibility.’ [P15, GP]

‘It’s massively a nurse-led thing, smears. Massively. I’m not even authorised to do a smear anymore. So it is sort of my responsibility to get it done, but I trust the nurses to do it as well.’ [P14, GP and Primary Care Network Clinical Director]

‘The nursing line managers are usually the better people to aim for, especially when it is cervical screening.’ [P07, Nurse]

The ‘importance’, ‘relevance’, and ‘controllability’ of the goal(s) targeted by feedback are identified by CP-FIT as critical factors in determining the likelihood of its success.

Feedback (component 3)

Interviewees were generally positive about the content of the feedback. Reports opened with headline information about the incidence of cervical cancer and several interviewees appreciated this contextual detail. One participant considered it particularly impactful:

‘I think it’s good just giving that deaths at the top because I think you don’t always… You can make the assumption, can’t you, that people attend screening and so therefore why would people be dying from cervical cancer?’ [P08, Medical Lead, Integrated Care Board]

Links to multilingual resources were identified as a useful feature that practice staff could use to ‘cut and paste into letters’ [P17, GP]. Most participants considered report length (three pages) and frequency (quarterly) appropriate. Indeed, some noted that increased frequency would be problematic as this would not allow sufficient time for improvement activity to take place and be reflected in the data, with negative consequences:

‘Particularly for the larger practices who would have to screen thousands to improve […] You need that 3 months to see any improvement. I think if you send a report and you’re the same [unchanged], it’s a bit disheartening.‘ [P04, Cancer Alliance Manager]

Interaction (component 4)

Reports were emailed to practice managers with the request that they be distributed among colleagues. However, most interviewees were unaware of the reports, suggesting a failure to reach the intended audience and representing a critical break in the feedback cycle. Several participants attributed this to existing high volumes of messages received by practices:

‘You’ve got competition for attention, haven’t you? A lot of stuff is thrown at you. Maybe that’s why we missed it, because it’s amongst a lot of other information being given.’ [P14, GP and Primary Care Network Clinical Director]

‘There’s so much important stuff, isn't there, like, this safeguarding meeting or this initiative to reduce antibiotic prescribing. And it just becomes overwhelming while you’re trying to see the patients as well.’ [P15, GP]

The latter quote (referring to another local feedback initiative on antibiotic stewardship) highlights the risk of multiple feedback programmes competing for finite attention. Even if feedback is received, there is likely to be a need for time and resource for teams to consider and plan actions:

‘I tend to find unless it’s been put on the agenda and discussed in a clinical meeting, it can get sometimes lost in the general email volume that comes through.’ [P13, GP]

Perception (component 5)

All participants responded positively to the reports’ appearance and legibility, considering them ‘understandable’, ‘informative’, and ‘easy to process’ (this aspect of feedback is termed ‘usability’ within CP-FIT):

‘I like how it’s nicely spread out. I like the different colour boxes because it helps sort of section the things. [...] I wish that other reports and newsletters were as nice and clear.’ [P17, GP]

An important element of audit and feedback interventions is the selection of an appropriate comparator to provide context for recipients to assess their performance and motivate change.27 Most participants welcomed the comparators used, with some referring to ‘competition’ and several nurses and managers identifying who could share best practice:

[Question: Do you think it’s useful to see how other practices are doing?]

‘You’re always wanting to improve […] nobody wants to be at the bottom of that list [laughs]. It does give you a bit more of a push.’ [P05, Practice Manager]

‘Yeah, I do. And you might broach them and say in meetings, is there anything you're doing that we should be doing? So it’s always good to see other practice nurses and learn from them if you can.’ [P12, Nurse]

One interviewee noted that the comparison with practices with similar demographic characteristics (termed ‘benchmarking’ in CP-FIT) would help to combat the potential response to feedback whereby poor performance is explained as being a result of patient characteristics:

‘I like the way it’s broken down into deprivation. Because I think that sometimes practices will say “But it’s harder for us than other practices because of our demographic”.’ [P08, Medical Lead, Integrated Care Board]

Acceptance (component 7)

Feedback is more likely to be accepted and acted on when recipients believe it originates from a credible source and accurately represents performance. Acceptance enhances the likelihood of progression through the cycle to intention, behaviour, and ultimately improvement in clinical performance.31 Most interviewees accepted the feedback, with one GP being particularly emphatic:

‘I think smears is one of those, so robust, isn’t it? I trust it, I think it’s probably the most trustworthy sort of data we get is smear data.’ [P14, GP and Primary Care Network Clinical Director]

By contrast, two participants were surprised to find comparatively low performance on their reports and described dismissing what was presented in favour of their own information:

‘I felt they don’t tally with our QOF results at all […]. I was shocked when I saw your figures. […] It did kind of hit me that: 80% in one practice and then we’re down here. And yet most of the living conditions are the same, the staffing’s the same. That did kind of make me think, “how are they doing this?”. And then I just went back to my own figures.‘ [P12, Nurse]

Intention and behaviour (components 8 and 9)

Intention and behaviour are individual components in the feedback cycle but were typically discussed together. The general view was that the intervention could potentially promote action within practices, but there was little evidence at present that it would inspire meaningful activity. The most reported intention was that reports would lead to discussion within teams about the implications and how screening might be increased, for example:

‘We are going to discuss it as a team and look at different ways of how to tackle cervical screening. […] I would like to find out who we’re missing and find out how we can get them in.’ [P10, Nurse]

Nurses described local meetings as a good opportunity to discuss screening practice and performance. This indicates how CASCADE could, potentially, prompt wider improved performance with successful approaches shared across practices:

‘Every month or so, there’s a nursing network meeting, so it might be quite nice to discuss how all the practices are coping, how they’re managing with their cervical screening and discuss it in the wider team, not just our practice.’ [P07, Nurse]

Some GPs reported that the feedback ‘planted a seed’ [P17, GP], raising awareness of the issue and prompting them to consider it when eligible patients presented for consultation. Whether this impact would endure, however, was uncertain:

‘Maybe increase the frequency of checking on the computer, have they had a smear in the last, however long. […] If I’ve got a lady coming in and we’re talking about her contraception or something, that would trigger me definitely to having a look at her smear record. So something like this would just sort of put it in my mind. How long that would last? I don’t know.’ [P17, GP]

‘It’s almost knowing what to do next in order to really make a difference. I think the reports are brilliant but it’s almost like “but what’s the next step?”.’ [P06, Public Health Specialist]

However, some participants expressed doubt about the likely impact of the reports in their practices. Lack of time and resources and competing priorities were cited as barriers. One participant felt that their practice was already doing as much as possible with the available resources:

‘I honestly don't think we could do anything more as a practice. I think we’re very proactive in trying to get patients to come in and apart from employing somebody specifically to push along people to come in for cervical screening, I don’t think there’s much else we could do, time constraints, etc.’ [P09, Nurse]

Clinical performance improvement (component 10)

Interviews offered no evidence that CASCADE had increased screening uptake in participating practices. Nevertheless, interviewees with strategic or leadership roles believed that the intervention had the potential to initiate positive change. One such participant stated that feedback should be accompanied by targeted work to support those identified as lower performers if it were to produce meaningful change:

‘Honestly, I do think just by providing this kind of intervention, information, that you will make a difference. It won’t be consistent across the board. […] Actually tracking it and see who is consistently underperforming. That’ll give you a sense of where those more targeted interventions will give you your best bang for buck.’ [P11, National Cancer Charity Lead]

[Could these reports prompt improvement?] ‘I think they could, if the right people are aware of them and some targeted interventions were put in place following on from receiving them.’ [P13, GP]

Discussion

Summary

The authors evaluated a pilot audit and feedback intervention (CASCADE) targeting cervical screening uptake in three PCNs in a large English city. Participants agreed that the clinical topic justified such an intervention; nurses expressed particular enthusiasm about the benefits of screening and pride in its delivery. Responses to report content and presentation were positive, with data considered valid, understandable, and relevant. Although suggested actions for practice improvement and links to resources were generally considered useful, there were preferences for more detailed action plans or links to software search tools.

However, the authors observed no evidence that the intervention had initiated organisational-level change. In most cases, participants were unaware of the reports before the interview. They reflected that reports were likely to have been hidden among the deluge of messaging received by practices, and that CASCADE would struggle to engage teams without additional measures to support impact. Such measures included sending reports specifically to influential practice leaders, rather than practice managers by default, and reserving facilitated discussion time in practice meetings.

Strengths and limitations

The CP-FIT framework includes a series of evidence-based, ‘high-confidence’ hypotheses specifying how to enhance feedback intervention effectiveness.31 These findings indicate that CASCADE was consistent with several of these, including ‘importance’, ‘relevance’, ‘benchmarking’, and ‘usability’.

The authors acknowledge four study limitations. First, most interviews took place around 6 months after sharing the first feedback report. Therefore, they may not have fully captured participant responses to repeated, longer-term feedback cycles. However, the observed poor awareness suggests that this is unlikely. Second, the 14 practice staff interviews undertaken included staff from only eight of 23 eligible practices. It is possible that reports had been received more successfully at the other practices, although the lack of response to the invitation to interview suggests otherwise. Third, the authors did not formally assess data saturation, so it is possible that this was not achieved. However, the sample comprised 17 individuals with a variety of roles and responsibilities, as well as local and national leadership experience. Fourth, while the authors consider their use of CP-FIT (a synthesis of 65 qualitative audit and feedback studies) a strength, it is possible that this framework may have restricted their line of enquiry. However, interviews included an open question where participants could report anything not covered elsewhere. In addition, the coding frame included space for findings that fell outside of the CP-FIT feedback cycle. The authors did not identify any instances where CP-FIT failed to capture the salient experiences of and influences on feedback within the context of cervical screening.

Comparison with existing literature

Audit and feedback has been studied extensively in primary health care. For example, similar interventions have been shown to reduce potentially harmful prescribing within practices in Leeds and the surrounding area.18,29 Cervical screening differs from prescribing as an intervention target in important ways: prescribing decisions are more clearly under clinician control while screening uptake relies on the active participation of patients. However, the apparent contrast between targets may be less marked than it appears. The consultation dynamic leading to prescribing decisions is complex and influenced heavily by patient expectation, while screening participation is enhanced by clinician endorsement and promotion.35

The authors believe that this is the first evaluation of an audit and feedback intervention on the uptake of cancer screening targeting UK primary care. While audit and feedback can generally be effective at improving screening participation,20 the evidence on cervical screening is limited. One study found that feedback including a practice target was more effective in improving screening rates than feedback including a peer comparator, but neither version was more effective than the control (which involved access to assistance in identifying overdue patients).23 Another reported that clinician use of an online feedback tool was associated with higher screening rates (1.4% absolute rise for cervical screening, equating to over 18 000 women in the Ontario Screening Programme).22 In contrast to the CASCADE reports, this tool included identification of individual patients needing screening.

In a large trial of emails enhanced with behaviour change techniques to encourage physicians to access an audit and feedback tool presenting patients’ last cancer screening date, fewer than half of those randomised opened the email message, with under a tenth clicking through the message.24 The lack of engagement reported in the current study is a further reminder of the critical need to make feedback information as visible and accessible as possible. Indeed, Vaisson et al noted that some recipients preferred to receive actionable data directly via email.24 Such ‘push’ approaches, such as delivering feedback to recipients, are considered more effective,31 yet this was the approach used by CASCADE and engagement remained low.

Implications for research and practice

One important, unanticipated finding was GPs’ perception that cervical screening was their nurses’ responsibility. Participants reported, or implied, that they had limited responsibility for screening uptake and therefore the intervention should be directed to nurses. Given that general practices are typically led by GPs, these responses suggest a problematic gap in oversight and prioritisation of cervical screening. GPs who lead practices might reasonably delegate screening delivery to nursing colleagues, but any leadership failures to actively promote this may ultimately impede optimal uptake. This intervention aimed to inspire action across teams, but the success of this approach may be contingent on cultures which value screening as a core practice responsibility to be promoted throughout the team, rather than a siloed activity for one group within the practice.

CASCADE reports presented information about inequalities within cervical screening (for example, lower uptake among deprived and minority ethnic groups)13,14 to raise awareness and suggest effective use of limited resources. The authors provided deprivation-matched practice achievement information to pre-empt defensive arguments that achievement was primarily the result of local demographic or case-mix factors.36,37 Such information could be useful in future interventions. Additionally, incorporating more granular detail into the Open Exeter data source (for example, screening uptake stratified by different ethnic minority groups) would make this readily available to practices rather than requiring them to search their own systems. It is a limitation of the current data and one that hinders action on reducing inequalities.

Cervical cancer is highly preventable through a combination of screening and vaccination. Accordingly, UK and global health policy has emphasised the need to optimise screening uptake. However, rates have declined and disparities exist between different patient groups. An intervention like CASCADE, targeting general practice teams, to promote uptake and particularly to provide suggested actions to support those who may face higher barriers to participation, could be a useful strategy to address the observed decline. Even if potential improvements are modest, given that the intervention can be deployed relatively simply at scale, important population benefits could result. The CASCADE reports were generally positively perceived (even if seldom received before interview) and the case for increasing screening uptake was universally accepted. However, improvement is unlikely without protected time for teams to discuss and plan responses.

A critical barrier identified here was that reports typically failed to reach target recipients. Thus, appropriate staff would need to be made aware of the intervention’s existence and the ways in which it may meet their needs, such as providing a practical basis for quality improvement that can in turn be used as evidence in appraisals or inspections. This might be achieved by incorporating an audit and feedback programme within incentive schemes such as the English Primary Care Directed Enhanced Scheme (DES), which reimburses practices for reviewing performance and planning improvements. In future rounds of DES, practices could be asked to review their cervical screening attainment and be signposted to a bespoke, publicly available report. If this were to be implemented, the authors recommend that adequate evaluation is undertaken to assess impact, which could be facilitated by staggering the rollout of a cervical screening component of DES and comparing changes in uptake between areas which had and had not yet received this focus on cervical cancer.

Feedback on cervical screening was positively perceived by most targeted primary care staff. However, such feedback is unlikely to change clinical practice if it does not pass practice gatekeepers and if practice staff cannot mount effective responses in the face of competing priorities. This evaluation has therefore highlighted the scope for enhancing feedback delivery and responses, and the potential of feedback to improve uptake of cervical screening.

Notes

Funding

This research was supported by funding from the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, PR-PRU-1217-21601. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder approved the study but had no involvement in the collection, analysis, and interpretation of data, or in writing the manuscript.

Ethical approval

This study was given a favourable opinion by the University of Leeds School of Medicine Research Ethics Committee (reference no. MREC 23-008).

Provenance

Freely submitted; externally peer reviewed.

Data

The dataset relied on in this article is available from the corresponding author on reasonable request.

Acknowledgements

The authors would like to express their gratitude to all participants in the study.

Competing interests

SHB was clinical lead for cancer (Leeds office of West Yorkshire Integrated Care Board) at the time the CASCADE intervention was developed and implemented and he works as a GP in one of the practices which was included in the intervention. TD was senior programme lead for cancer (Leeds office of West Yorkshire Integrated Care Board) at the time the CASCADE intervention was developed and implemented.

  • Received October 6, 2025.
  • Revision received December 12, 2025.
  • Accepted February 2, 2026.

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Evaluation of an audit and feedback intervention to improve uptake of cervical screening
Erica di Martino, Tasneem Khan, Stephen H Bradley, Tom Daniels, Robbie Foy, Sarah Alderson, Richard D Neal, Thomas A Willis
BJGP Open 6 October 2026; BJGPO.2025.0218. DOI: 10.3399/BJGPO.2025.0218
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British Journal of General Practice