Background: The impact of cervical cancer can be reduced when detected and followed up in a timely manner, yet follow-up after abnormal screening results remains below WHO 2030 targets in many countries, including Belgium. Despite an organized screening programme and the introduction of a fail-safe mechanism notifying providers when follow-up is overdue, delays persist and factors explaining untimely follow-up remain insufficiently understood.
Objective: This study explored healthcare providers’ experiences with and perspectives on factors contributing to untimely follow-up of abnormal cervical cancer screening results in Flanders, across multiple levels: patient, provider, practice, and system.
Methods: Semi-structured group interviews (N=14) were conducted with healthcare providers (i.e., general practitioners (GPs) and gynaecologists) involved in cervical cancer screening across four Flemish provinces. Participants were recruited through professional organisations, local networks and snowball sampling. Overall, 120 healthcare providers participated (n=8-9/group) between September-November 2025. Interviews were conducted in Dutch, audio-recorded, transcribed verbatim, pseudonymized, and averaged 60 minutes. Analysis followed the six-step thematic approach of Naeem et al. (2023), combining a deductive multilevel framework with inductive coding. Two independent researchers conducted the analysis.
Results: Although these were considered trivial by healthcare providers, patient-related factors included socio-demographic characteristics such as migration background and language proficiency, as contributors to misunderstanding results. Limited awareness of the implications of abnormalities, difficulties navigating digital platforms, and severity of the lesion grade were perceived as hindering patients’ ability to interpret and act on follow-up needs. Providers also noted variation in patients’ autonomy, initiative, and whether they had an established gynaecologist when referral was required.
Provider-related factors were mentioned most frequently. Communication practices varied, including whether clinicians communicated only abnormal results or all results. Proactive communication was considered helpful, although discussing human papillomavirus (HPV), relationships, and sexual health was often described as complex. Interdisciplinary coordination differed substantially, with frequent misunderstandings about responsibilities for communicating results and initiating follow-up. High workload, competing priorities, and variable use of reminder systems further contributed to missed or delayed action. Practice-level organisation also shaped follow-up: administrative support in monitoring results and nurses’ involvement in screening and scheduling follow-up appointments were perceived as facilitators.
System- and policy-level factors included fragmented medical software, lack of centralized information, and variability in laboratory communication. Both GPs and gynaecologists described delays, limited visibility of each other’s results, and challenges managing high volumes of incoming information in electronic mailboxes. Waiting times for gynaecology appointments and inconsistencies in recommended follow-up intervals presented further barriers for timely follow-up. Suggested improvements included revising task distribution across care levels, integrating AI tools for follow-up tracking, and strengthening patient health education. Awareness of the national fail-safe mechanism was low, with only a few gynaecologists reporting receipt of such notifications.
Conclusion: Untimely follow-up appears driven predominantly by organisational, communication, and system-level shortcomings rather than patient-related factors. Although screening uptake knows a social gradient, it remains unclear whether this also applies to follow-up. Enhancing interdisciplinary communication, improving digital interoperability, and increasing awareness and use of the fail-safe mechanism represent critical, actionable levers to ensure timely and equitable follow-up care.