Background
Economic incentives are increasingly discussed as strategies to improve adherence to cervical cancer screening. However, their ethical acceptability and practical feasibility remain debated, particularly in publicly funded European health systems, where concerns related to trust, equity and professional roles are prominent.
Objectives
To explore healthcare professionals’ perspectives, opinions and experiences regarding the use of economic incentives to improve women’s adherence to cervical cancer screening in Italy.
Methods
An exploratory-descriptive qualitative study was conducted using semi-structured interviews. Between April and August 2025, 24 healthcare professionals (midwives, nurses and physicians) involved in public health and cancer prevention from different Italian regions were recruited through professional networks. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis supported by qualitative software. Data saturation was achieved. The interview guide and interpretation were informed by behavioural and acceptability frameworks.
Results
Three main themes emerged. First, participants discussed the ethical implications of economic incentives, highlighting concerns related to autonomy, dependency and socio-economic inequalities. Incentives were considered acceptable only when symbolic and aimed at facilitating access rather than providing direct monetary remuneration. Second, trust-based relationships between women and healthcare professionals were identified as central to screening adherence, with concerns that incentives could undermine relational, educational and communicative aspects of care if implemented in isolation. Third, pre-existing stigma associated with human papillomavirus was described as a persistent barrier influencing women’s engagement with cervical screening. Additional subthemes addressed educational determinants, organisational and access barriers, interactions with political institutions, and the potential integration of screening and vaccination programmes.
Conclusions/Implications for practice or policy
Healthcare professionals perceive economic incentives as potentially useful tools to improve adherence to cervical cancer screening, provided they are embedded within ethically grounded, equity-oriented and trust-based frameworks. Incentives should complement, not replace, education, relational care and organisational improvements. Involving frontline professionals in the design of incentive-based interventions is essential to ensure acceptability and inform context-sensitive cancer prevention policies.