Mapping community-based health promotion strategies for cervical cancer screening uptake: A scoping review of intervention components, delivery models and implementation gaps

Abstract

Objectives

To map community-based health-promotion strategies used to improve cervical cancer screening uptake and to identify intervention components, delivery models, equity targets and implementation gaps.

Study design

Scoping review.

Methods

The review followed PRISMA-ScR and JBI population–concept–context guidance. PubMed/MEDLINE, PubMed Central, publisher pages, ClinicalTrials.gov-linked records and DOI records were searched from inception through 3 June 2026, with backward and forward citation chasing. English-language original intervention or implementation studies with a community-facing screening-promotion component were eligible. One reviewer screened all full texts, and two coauthors validated the final inclusion decisions. Data were charted and synthesized descriptively across intervention, outcome, implementation and equity variables.

Results

Twenty-one original intervention or implementation studies were included in the evidence map. Nine contextual sources informed the background and five methodological sources informed review conduct but were not counted as included original evidence. Six recurring strategy families were observed: lay or peer workforce models, culturally tailored education, navigation and barrier reduction, HPV self-sampling, mHealth reminders and integrated outreach. Across heterogeneous designs, multicomponent approaches commonly linked trusted messengers, tailored communication, convenient screening access and active follow-up; no comparative effectiveness ranking was undertaken.

Conclusions

Community-based cervical screening promotion can be designed and evaluated as a prevention cascade rather than as a one-time awareness activity. Future programmes should measure movement from engagement and access through screening completion, result delivery, triage and treatment linkage.

What this study adds.

• •Maps how community workforce, cultural tailoring, navigation, self-sampling and digital prompts combine rather than work as isolated components.
• •Shows that included multicomponent models commonly linked trusted messengers with screening access, result delivery and follow-up.
• •Identifies fidelity, cost, equity reach, treatment linkage and sustainability as persistent reporting gaps.

Implications for policy and practice.

• •Programmes should begin with the least-screened population and build a pathway from trust to treatment linkage.
• •HPV self-sampling and community workers can be paired with navigation to reduce access and institutional barriers.
• •Evaluations should report cascade completion, not screening uptake alone.

Plain English summary

Cervical cancer can often be prevented when people receive screening and follow-up care. Many people who are eligible for screening do not attend because services are difficult to reach, the test feels embarrassing or frightening, or information is not provided in a trusted language or setting. This scoping review mapped studies that used community-based health promotion to increase cervical screening. The evidence shows that stronger programmes do more than give information. They use trusted community workers, culturally relevant education, practical help such as navigation or reminders, easier testing options such as HPV self-sampling, and clear follow-up after results. The review therefore describes screening promotion as a prevention cascade: engagement, communication, access, screening, result delivery and treatment linkage. Programmes should report not only how many people complete the first test, but also whether people receive results, attend follow-up and obtain treatment when needed.

1. Introduction

Cervical cancer is largely preventable, yet screening coverage remains uneven across social, geographic, cultural and health-system contexts. The global elimination strategy places screening coverage alongside human papillomavirus vaccination and treatment, making participation in high-performance screening a core prevention metric rather than a peripheral service outcome. [1,2] The continuing global burden of cervical cancer, together with modelling evidence showing that screening remains necessary even when vaccination is scaled, underscores why screening access remains central to public health practice. [3,4]

Low screening uptake is rarely explained by knowledge alone. Under-screened populations may face fear of pelvic examination, stigma, transport costs, language barriers, lack of insurance, mistrust, low perceived risk or uncertainty after a positive result. These barriers and the need for reliable management of screen-positive participants are documented across global guidance and intervention reviews. [2,[5], [6], [7], [8], [9]] Community-based promotion can therefore be understood as a linked pathway that builds trust, translates risk information into locally meaningful language, reduces practical barriers and supports follow-up. [[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24]] This framing is especially important for programmes seeking to reduce inequalities rather than merely increase aggregate participation.

Previous reviews have assessed broad intervention categories, educational interventions, lower socioeconomic groups, rural populations and low- and middle-income settings. [[5], [6], [7], [8], [9]] However, fewer reviews have mapped the implementation architecture of community-facing strategies: who delivers the intervention, where access to screening is created, how cultural barriers are addressed and whether screening is connected to triage and treatment. The same nominal label can describe very different public health designs. A home visit that only encourages clinic attendance differs from a home visit that offers HPV self-collection, transports the specimen and links participants with follow-up care.

Community-based health promotion is especially relevant because cervical screening depends on both demand and service design. A message delivered in a clinic may reach people already close to care, whereas community delivery can reach people who are socially, geographically or institutionally distant from routine services. At the same time, community placement alone is insufficient if the intervention does not address privacy, affordability, trust and follow-up after abnormal results. For this reason, implementation details are not secondary features; they define whether a screening-promotion strategy can plausibly reduce preventable cancer burden.

This scoping review therefore maps community-based health promotion strategies for cervical cancer screening uptake and identifies intervention components, delivery models, equity targets and implementation gaps. The review asks how community strategies move participants from awareness to action and what features appear necessary for prevention practice.

2. Methods

2.1. Review design and reporting

A scoping review design was selected because the literature spans heterogeneous populations, screening modalities, intervention agents, outcomes and health-system settings. The review was guided by PRISMA-ScR, the Arksey and O'Malley framework, Levac and colleagues' refinements, JBI guidance and methodological guidance on choosing scoping rather than effectiveness-synthesis designs. [[25], [26], [27], [28], [29]]. The objective was not to pool effect sizes. Instead, the synthesis charted intervention components, delivery models, implementation features and gaps.

2.2. Eligibility criteria

Eligibility was structured using population–concept–context logic. Eligible studies included women or other people eligible for cervical screening and a community-facing strategy intended to increase screening attendance, completion, intention, readiness, navigation or linkage to screening. Original intervention, randomised trial, cluster trial, quasi-experimental, pilot, implementation and economic studies were included when they reported a cervical screening-related outcome or implementation endpoint. HPV vaccination-only studies, treatment-only studies, prevalence surveys without a promotion strategy, opinion papers and studies without screening-related outcomes were excluded. Table 1 summarises the operational scope boundaries.

Table 1.

Eligibility framework and population–concept–context scope boundaries.

Domain	Operational definition
Population	Women or other people eligible for cervical cancer screening, including general, under-screened, never-screened, rural, migrant, ethnic minority, low-income, safety-net or low-resource populations.
Concept	Community-based or community-facing health promotion strategies intended to increase screening attendance, completion, uptake, intention, readiness, knowledge, barrier reduction, navigation or linkage to screening.
Context	Home, community, faith, worksite, primary-care outreach, community health campaign, rural, safety-net, low-resource and underserved settings.
Included evidence	Original intervention, randomised trial, cluster trial, quasi-experimental, pilot, implementation and economic studies with a cervical screening-related outcome or implementation endpoint.
Excluded evidence	HPV vaccination-only studies, treatment-only studies, prevalence-only surveys without a promotion strategy, opinion papers and studies without cervical screening-related outcomes.

2.3. Information sources and search strategy

A core concept structure was used for PubMed/MEDLINE and adapted to the syntax and search functions of each information source rather than replicated verbatim. Searches covered records from database inception through 3 June 2026 and charted English-language full texts. Controlled vocabulary and free-text terms covered cervical cancer screening, Pap testing, visual inspection with acetic acid, HPV testing, self-sampling, community health workers, lay health advisors, promotoras, female community health volunteers, navigation, reminders, SMS, health education and uptake. The PubMed/MEDLINE string was: ("cervical cancer screening" OR "pap test" OR "HPV testing" OR "visual inspection with acetic acid" OR VIA) AND ("community-based" OR "community health worker" OR "lay health advisor" OR promotora OR volunteer OR "patient navigation" OR "self-sampling" OR "home visit" OR SMS OR reminder OR "health education") AND (uptake OR participation OR attendance OR adherence OR completion). PubMed Central, publisher pages, ClinicalTrials.gov-linked records and DOI records were searched using title, author, trial identifier and DOI combinations. Backward references and forward citations of recent reviews and eligible studies were screened against the same criteria.

2.4. Source selection, data charting and synthesis

One reviewer screened titles, abstracts and all available full texts against Table 1, and two coauthors validated the final inclusion decisions; disagreements were resolved through discussion. The charting form captured country, population, study design and sample, community actor, recruitment pathway, intervention components, cultural adaptation, screening modality, comparator, quantitative uptake or implementation endpoint, follow-up after positive results and equity-related notes. Equity variables included rurality, income or safety-net status, racial or ethnic minority status, migration and language concordance, transport or participant costs, digital access and differential follow-up when reported. Fig. 1 distinguishes the 21 included original studies from nine contextual and five methodological sources that informed the background or review conduct but were not counted as included evidence.

Fig. 1.

PRISMA-ScR source-selection flow diagram. The diagram distinguishes the 21 included original studies from nine contextual and five methodological sources used only to frame the review.

The strategy families and six-stage prevention cascade were developed iteratively. Initial charting categories reflected the review question; repeated comparison across the included studies refined the categories and cascade stages. Multicomponent interventions could receive more than one strategy-family code, while their dominant delivery mechanism and the cascade stages addressed were recorded separately. Evidence was synthesized descriptively as recurring patterns rather than pooled or ranked for comparative effectiveness. Critical appraisal was not used as an exclusion criterion, consistent with the scoping-review purpose.

3. Results

3.1. Search results and study characteristics

As shown in Fig. 1, 146 records were identified. After 18 duplicates and 27 non-original or background records were removed, 101 records underwent title and abstract screening; 48 were excluded. Fifty-three full texts were assessed. Thirty-two were not included as original evidence: 14 contextual or methodological sources were used only to frame the background and methods, six were not eligible intervention or implementation studies, five lacked a sufficient community-facing component and seven lacked adequate screening or follow-up outcomes. Twenty-one original studies were included in the evidence map. The available title and abstract screening log did not retain reason-specific counts for the 48 exclusions.

The 21 included original studies covered home outreach, health campaigns, faith or worksite locations, rural or semi-urban communities, and safety-net or low-income health systems. They included CHW home visits, South Asian CHW programmes, female community health-volunteer referral, multicomponent rural interventions, promotora or lay-advisor navigation, faith-placed and worksite approaches, mailed self-sampling, community health campaigns, SMS or eVoucher systems and community self-sampling with SMS follow-up. [[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24],[30], [31], [32], [33], [34], [35]] Table 2 reports the complete evidence chart used to derive the strategy typology.

Table 2.

Complete evidence chart of the 21 included original studies: populations, intervention models, quantitative outcomes and implementation or equity implications.

Refs.	Population/setting	Design, strategy and modality	Quantitative outcome	Implementation and equity notes
Arrossi et al. [10]	Argentina; 6013 women aged ≥30 years reached by public-system CHWs	Population-based cluster RCT; home education plus direct offer of HPV self-collection	HPV testing: 86% (2618/3049) vs 20% (599/2964); RR 4.02, 95% CI 3.44–4.71	Combining a trusted workforce with immediate home access produced a large within-trial uptake difference; follow-up after positive tests remained a separate cascade requirement.
Wong et al. [11]	Hong Kong; 42 South Asian women recruited through six ethnic-minority associations	Pilot cluster-randomized wait-list trial; CHW-led culturally and linguistically tailored multimedia education	Perceived benefits improved (p = 0.001) and perceived barriers declined (p = 0.02); no significant between-arm difference in screening uptake or intention	Feasibility and belief change were demonstrated, but this pilot did not establish an uptake effect.
Wong et al. [12]	Hong Kong; 387 South Asian women completing follow-up through six nongovernmental organizations	Assessor-blind cluster RCT; education, monthly calls and navigation over 3 months	Screening uptake was 97.9% (191/195) vs 52.6% (101/192) at 3 months (p = 0.005); perceived barriers also decreased	A culturally concordant multicomponent pathway linked education to navigation and high observed uptake.
Shrestha et al. [13]	Nepal; 690 women aged 30–60 years in 14 semi-urban clusters; 646 completed follow-up	Cluster RCT; FCHV home education, referral and follow-up; facility-based VIA	Screening uptake increased relative to control: RR 1.48, 95% CI 1.32–1.66 (p < 0.01); median knowledge rose from 2 to 6	Volunteer networks were effective when referral was linked to available local screening services.
George and Batra [14]	India; 419 women aged 30–60 years in rural and tribal settlements	RCT; nurse-led small-group education, reinforcement, telephone reminders, navigation and local screening camp	Pap testing in the intervention arm rose from 4.1% at baseline to 16.7% at 1 month and 71.5% at 6 months; between-group screening-behaviour difference p < 0.001	Repeated contact, navigation and nearby service provision formed a multicomponent access pathway.
Savas et al. [15]	United States; 627 low-income, primarily uninsured Latinas overdue for breast and/or cervical screening	Individual RCT; promotora one-to-one education plus navigation calls versus printed information	For Pap testing, a significant effect was limited to women aged ≥50 years: 64.5% vs 43.5% per protocol (p = 0.019)	The subgroup-specific result does not support a uniform cervical-screening effect across all ages.
Paskett et al. [16]	United States; 286 Ohio Appalachian women from 14 clinics who needed risk-appropriate Pap testing	RCT; two LHA visits, two calls and four postcards over 10 months versus usual care	Medical-record outcome: 51.1% vs 42.0%; OR 1.44, 95% CI 0.89–2.33 (p = 0.135). Self-report: 71.3% vs 54.2%; OR 2.10, 95% CI 1.22–3.61 (p = 0.008)	The primary record-based estimate was not statistically significant; divergence from self-report highlights outcome-verification limitations.
Studts et al. [17]	United States; 345 Appalachian women aged 40–64 years overdue for screening	Community RCT; faith-placed LHA home visits and newsletters versus wait-list control	Self-reported Pap testing: 17.6% vs 11.2%; OR 2.56, 95% CI 1.03–6.38 (p = 0.04)	Faith settings and lay advisors extended reach, although absolute uptake remained modest.
Pretsch et al. [18]	United States; 665 under-screened women from low-income backgrounds included in primary analysis	Phase 3 RCT; mailed HPV self-collection plus scheduling assistance versus scheduling assistance alone	Screening uptake: 72% (317/438) vs 37% (85/227); RR 1.93, 95% CI 1.62–2.31	Mailed access plus scheduling support reduced clinic and appointment barriers.
Winer et al. [19]	United States; 31,355 individuals aged 30–64 years in an integrated health system	RCT stratified by screening history; education, direct-mail and opt-in HPV self-sampling strategies	Among those due, direct mail achieved 61.7% vs 47.6% with education (+14.1 percentage points, 95% CI 11.2–16.9); among those overdue, 35.7% vs 18.8% (+16.9 points, 95% CI 13.8–20.0)	Proactive mailing showed a stronger within-trial pattern than education or opt-in access, with effects varying by screening history.
Montealegre et al. [20]	United States; 2474 under-screened safety-net patients; 94.0% from racial or ethnic minoritized groups	Pragmatic RCT; telephone reminder, mailed self-collection, or mailed self-collection plus navigation	Participation: 17.4%, 41.1% and 46.6%, respectively; relative participation versus reminder 2.36 (95% CI 1.99–2.80) and 2.68 (95% CI 2.27–3.16)	Self-collection improved access in a safety-net population; navigation added a modest increment.
Huchko et al. [21]	Kenya; 4944 women aged 25–65 years across 12 rural communities	Cluster RCT; HPV self-collection offered through community health campaigns versus facilities	Population-level screening uptake: 60.0% vs 37.0% (p < 0.001); treatment acquisition among HPV-positive women: 39.2% vs 31.5% (p = 0.408)	Community campaigns increased screening reach, but low treatment completion in both arms exposed a downstream cascade gap.
Modibbo et al. [22]	Nigeria; 400 women aged 30–65 years in a semi-urban district	Community randomized trial; HPV self-collection versus hospital collection	Screened: 93% (185/200) with self-collection vs 56% (113/200) with hospital collection (p < 0.001)	Self-collection substantially reduced the facility-access requirement; nearly all returned specimens were adequate for testing.
Mezei et al. [23]	Uganda; cost-effectiveness model informed by the 500-participant ASPIRE trial	Economic evaluation of community HPV self-collection with VIA triage and a modeled screen-and-treat strategy	Modeled HPV screen-and-treat reduced lifetime cervical-cancer risk from 4.2% to 3.5%, 2.8% and 2.4% with one, three and five lifetime screens; ICERs US$130, US$240 and US$470 per year of life saved	The analysis supports potential value but is model-based and depends on test costs, treatment linkage and assumptions.
Erwin et al. [24]	Tanzania; 851 women aged 25–49 years with mobile-phone access in urban and rural catchments	Double-blind RCT; behaviour-change SMS, SMS plus transport eVoucher, or one informational SMS	Overall attendance was 11.9%; versus control, OR 3.0 (95% CI 1.5–6.2) for SMS and OR 4.7 (95% CI 2.9–7.4) for SMS plus eVoucher	Adding transport support addressed both behavioural and financial-access barriers; eligibility required phone access.
Abu et al. [30]	Ethiopia; 2140 previously unscreened women aged 30–49 years at eight public health centres	Cluster RCT; one-to-one education plus brochure integrated into maternal and child health visits; VIA available	Overall, 215 (10.0%) screened; 152 were in intervention centres and 63 in control centres. Intervention allocation AOR 2.43, 95% CI 1.58–2.90	Service-linked education increased the odds of uptake, but overall coverage remained low.
Samami et al. [31]	Iran; 120 women allocated equally to intervention and control groups	Randomized trial; two 90-min Health Belief Model education sessions	Post-training Pap-test performance was 31.7% in the intervention group versus 3.3% in control (p = 0.001)	Education changed beliefs and reported function; access and longer-term maintenance were not evaluated.
Rosser et al. [32]	Kenya; 419 previously unscreened women eligible for free screening in a rural programme	Randomized trial; brief cervical-cancer health talk versus information about free screening	Screening uptake: 58.9% (122/207) vs 60.9% (129/212); χ2 = 0.16 (p = 0.69). Knowledge increased more after education	When both groups had free access information, added education improved knowledge but not screening uptake.
Romli et al. [33]	Malaysia; 210 female entrepreneurs in two districts	Controlled community trial; multimodal education plus monthly SMS reminders versus educational talk alone	Intervention uptake rose 48.0%→68.0%→79.0% (both p < 0.001); control rose 63.0%→76.0% (p = 0.003)	Both education formats coincided with gains; repeated text reminders provided an additional cue to action.
Abdullah et al. [34]	Malaysia; 403 female teachers from 40 public secondary schools who were never or infrequently screened	Cluster RCT; worksite screening initiative versus usual opportunistic care	Pap-test uptake: 18.1% vs 10.1%; adjusted OR 2.44, 95% CI 1.29–4.62 (p < 0.05)	Worksite delivery placed screening within routine working life, although absolute uptake remained modest.
Joseph et al. [35]	Uganda; 194 eligible rural community-health-fair participants	Prospective implementation study; community HPV self-sampling with SMS results and referral	159/194 (82%) self-sampled; 27 (17%) were hrHPV-positive; 17 received SMS instructions and 6/17 (35%) attended follow-up	High initial participation did not translate into adequate follow-up; transport, disbelief, childcare and absent symptoms were reported barriers.

Note. RR = risk ratio; OR = odds ratio; AOR = adjusted odds ratio; CI = confidence interval; CHW = community health worker; FCHV = female community health volunteer; VIA = visual inspection with acetic acid; hrHPV = high-risk human papillomavirus; ICER = incremental cost-effectiveness ratio.

3.2. Strategy families

Six strategy families were identified: lay or peer workforce models, culturally tailored education, navigation and barrier reduction, HPV self-sampling, mHealth reminders and integrated outreach in community settings. These families frequently overlapped, so the synthesis mapped functions and recurring patterns rather than assigning a comparative effectiveness rank. Community workers and lay advisors supplied trust, language concordance and local legitimacy; culturally tailored education addressed stigma, fear and perceived risk; navigation supported scheduling, interpretation of results and access to services; and self-sampling shifted testing beyond the clinic. [[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24],[30], [31], [32], [33], [34], [35]]

Several included studies combined trusted messengers with direct screening access. Community health workers offering HPV self-collection during home visits were associated with higher uptake within the EMA trial. [10] Volunteer referral in Nepal and CHW programmes in Hong Kong also linked locally embedded delivery with available services. [12,13] Mailed or direct HPV self-collection created alternative access routes for under-screened or safety-net populations, particularly when paired with scheduling assistance or navigation. [[18], [19], [20]] These observations describe patterns across heterogeneous studies and should not be interpreted as indirect comparative-effectiveness estimates.

Table 2 shows that the same strategy family can operate at different points in the prevention cascade. Education can prepare participants to consider screening, although some trials improved knowledge without improving uptake. [11,32] Navigation and self-sampling more directly altered access or completion pathways in several trials. [10,[12], [13], [14], [15], [16], [17], [18], [19], [20],22] SMS reminders were associated with attendance in Tanzania, particularly when transport support was added, but their relevance depends on phone access, privacy, literacy and service capacity. [24] Integrated outreach through campaigns, worksites or faith settings extended reach in several contexts while still requiring systems for results and treatment linkage. [17,21,34,35]

3.3. Equity and cascade gaps

The mapped interventions often targeted populations experiencing screening inequities, including rural women, low-income groups, South Asian women, Latinas, Appalachian communities and safety-net patients. [[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20],24,34] Equity data were synthesized descriptively from reported rurality, income or safety-net status, race or ethnicity, migration and language concordance, transport or participant cost, digital access and differential follow-up. Reporting was inconsistent: many studies identified a priority population but provided limited stratified data on who completed screening, received results or reached follow-up care.

A recurring implementation gap concerned completion of the screening cascade rather than initial uptake alone. Community campaigns in Kenya reached more women than facility delivery, but treatment acquisition remained low in both arms [21]. Community self-sampling in Uganda achieved 82% participation, yet only 35% of hrHPV-positive participants who received SMS instructions attended follow-up. [35] Fig. 2 therefore maps engagement, communication, access, screening completion, result delivery, triage and treatment linkage to the included evidence.

Fig. 2.

Evidence-linked prevention-cascade architecture for community-based cervical cancer screening promotion. Citation numbers within each stage identify contributing included studies; stages summarize recurring functions rather than comparative effectiveness.

4. Discussion

This scoping review organizes community-based cervical screening promotion as a prevention cascade. Across the mapped evidence, several multicomponent interventions linked a community interface, culturally adapted communication, a practical route to screening and follow-up support. [10,[12], [13], [14], [15], [16], [17], [18], [19], [20]] These are recurring patterns across heterogeneous studies, not a comparative ranking. Table 2 also shows that direct access did not guarantee downstream completion: treatment or follow-up remained limited in some community-based HPV programmes. [21,35]

The prevention-cascade framing distinguishes mechanisms that are often grouped under one intervention label. Education primarily addresses knowledge, perceived susceptibility, embarrassment and fear; CHWs may add relational trust and language concordance; navigation can reduce scheduling, transport and interpretation barriers; and self-sampling changes the physical access point. [[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24],[30], [31], [32], [33], [34], [35]] These mechanisms are complementary, but their contribution cannot be isolated reliably from multicomponent trials without component-specific comparisons.

This distinction is important for public health practice. Improving knowledge is not equivalent to creating access: two educational studies increased knowledge or beliefs without a clear overall uptake advantage. [11,32] Conversely, home or mailed self-collection, local campaigns, navigation and transport support altered the route to screening in several trials. [10,[12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24]] Community placement also varied: faith and worksite programmes used trusted settings, whereas community-engaged programmes incorporated local actors into recruitment, messaging or follow-up. [[15], [16], [17],34] These patterns should guide hypothesis generation and programme design rather than imply cross-study comparative effectiveness.

For policy and programme design, cervical screening promotion can begin with the population least likely to attend routine services and specify a pathway from trust to treatment linkage. Programme descriptions should identify who delivers the message, how cultural and language barriers are addressed, which screening route is offered, how results are communicated and how positive results are followed. The need for this full pathway is illustrated by high initial self-sampling or campaign reach followed by limited treatment or follow-up in Kenya and Uganda. [21,35] A first screening test is therefore an intermediate rather than final prevention endpoint.

The review identifies reporting gaps that limit transferability. Uptake was commonly reported, whereas fidelity, cost, workforce training, equity reach, participant burden, result delivery, triage, treatment completion and sustainability were less consistent. The Ugandan cost-effectiveness analysis illustrates how estimates depend on testing costs, treatment linkage and modeled assumptions, 28 while SMS and self-sampling studies show that access technologies remain contingent on transport, communication and service readiness. [[18], [19], [20], [21], [22], [23], [24],35] Future evaluations should report cascade completion and implementation conditions rather than uptake alone.

Equity should be treated as a design and reporting requirement. Although multiple studies intentionally recruited rural, low-income, ethnic-minority or safety-net populations, 15–25, 29, 34 few reported differential attrition after screening, participant costs or follow-up across intersecting barriers. The practical implication is to match the intervention to the documented barrier profile: culturally concordant messengers where mistrust or language barriers dominate; self-sampling, local campaigns or navigation where access barriers dominate; and result-delivery and treatment navigation where downstream retention is weak. This interpretation is descriptive because no formal equity-effectiveness synthesis was conducted.

This review has limitations. First, the evidence map relied on open bibliographic and publisher-accessible records, trial-register links, DOI records and citation chasing rather than archived exports from multiple subscription databases. This may have produced incomplete retrieval and selection bias, particularly for non-English and poorly indexed studies. Second, the exact reason-level distribution for 48 title and abstract exclusions was not retained in the available screening log; Fig. 1 therefore reports the total transparently without inventing subgroup counts. Third, one reviewer screened all full texts, although two coauthors validated the final inclusion set. Fourth, no meta-analysis was undertaken because the question concerned strategy mapping and the populations, modalities, comparators and outcomes were heterogeneous. Fifth, critical appraisal was not used for exclusion, consistent with scoping-review methods. Finally, equity variables were reported unevenly, so conclusions about differential reach and follow-up remain descriptive implementation signals rather than comparative effects.

In conclusion, community-based health promotion for cervical cancer screening can be designed as more than a one-time awareness activity. The 21-study evidence map identified six recurring strategy families: lay or peer workforce models, culturally tailored education, navigation and barrier reduction, HPV self-sampling, digital reminders and integrated outreach. Organizing these functions as a prevention cascade—engagement, communication, access, screening completion, result delivery and follow-up care—makes downstream implementation gaps visible without implying a comparative ranking across heterogeneous studies.

For public health practice, programmes should connect under-screened populations with feasible screening routes and reliable follow-up after results. Future studies should report fidelity, cost, equity reach, result notification, triage, treatment completion and sustainability so that community promotion contributes to prevention rather than isolated testing.

Ethics statement

Not applicable. This scoping review used published data and did not involve new human-participant data collection.

CRediT authorship contribution statement

Nanik Setiyawati: Conceptualization, Methodology, Investigation, Formal analysis, Data curation, Visualization, Writing – original draft, Project administration. Sri Sulistyowati: Methodology, Validation, Supervision, Writing – review and editing. Heru Priyanto: Methodology, Validation, Supervision, Writing – review and editing. All authors approved the final version submitted for publication.

Data availability

All data charted for this review are derived from the published sources cited in the reference list and the complete evidence chart in Table 2.

Declaration of generative AI and AI-assisted technologies in the manuscript preparation process: During preparation of this work, the authors used ChatGPT to assist with literature organisation, manuscript editing, formatting and preparation of submission documents. The authors reviewed and edited the content as needed and take full responsibility for the content of the submitted manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.