Can a two-hour conversation make cancer screening easier to understand and less intimidating? A UK study suggests that community-designed workshops may help, although the researchers caution that the evidence is preliminary. Among 169 Muslim women who were behind on at least one recommended screening programme, average cancer knowledge scores rose substantially after a workshop and remained higher a year later.
The mean score on a 14-point knowledge test increased from 3.2 before the workshop to 7.4 at the 12-month assessment, a gain of 4.2 points. Participants also reported greater willingness to attend breast, cervical and bowel cancer screening. Yet the study had no comparison group, and reported screening attendance was not independently verified. The findings show a promising approach to a difficult public-health problem, not proof that the workshops caused more women to be screened.
Why access to screening is more than receiving an invitation
Breast, cervical and colorectal cancer screening can identify disease or precancerous changes before symptoms appear. In the United Kingdom, national programmes invite people according to their age and screening history. Receiving an invitation, however, does not guarantee that a person feels informed, can navigate an appointment or trusts that the process will respect their needs.
Screening barriers can involve practical issues, such as transport, appointment times and difficulty using home testing kits. They can also involve embarrassment, uncertainty about risk, concern about pain, previous experiences with healthcare and preferences about the gender of a clinician. These issues are not unique to any one faith or ethnic community.
The new study focused on Muslim women in Glasgow and North East England, where researchers had identified gaps in participation and opportunities to design support with local communities. Its central question was whether a culturally relevant, peer-led workshop could improve knowledge, attitudes and engagement with three different screening programmes.
What the researchers actually tested
The study, called IMCAN, was published on 9 October 2026 in Frontiers in Public Health. Researchers led by Floor Christie-De Jong evaluated a two-hour educational workshop developed through community-based participatory research. The team had previously worked with Muslim women to identify barriers and design the messages and activities.
Each workshop combined four elements: a discussion facilitated by peers, health education and questions with a female general practitioner, recorded testimonials from Muslim women about cancer and screening, and a session with a female religious scholar discussing Islamic perspectives on health and screening. The aim was informed choice, rather than pressure to accept every test.
The intervention used a framework that considers capability, opportunity and motivation together. This matters because giving someone more facts may not solve an inconvenient appointment, a lack of childcare or a concern about privacy. Religious framing was one part of a wider intervention built around medical information, practical guidance and community participation.
Between February and June 2024, the team delivered 16 workshops, including ten online sessions and six in person. They were held or organised through community settings in Scotland and North East England. Participants could complete surveys in English, Arabic, Urdu or Bengali, using online or paper formats.
How 256 workshop attendees became the study sample
A total of 256 women attended the workshops. Of these, 234 consented to the research and completed the initial questionnaire. The researchers excluded 65 who were already up to date with every screening programme for which they were eligible. This left 169 women aged 25 to 74 for the main analysis.
Among those 169 participants, 92 lived in England and 77 in Scotland. Their average age was 47 years. Of the women with recorded ethnicity data, 128, or 76.6%, were classified as Asian. The group included women with varied education levels and home languages, including Urdu, English and Bengali.
At baseline, 148 participants were behind on cervical screening, 52 on breast screening and 22 on colorectal screening. These groups overlap because a participant could be behind on more than one programme. The small bowel-screening subgroup is especially important when interpreting later percentages.
A before-and-after design, not a randomised trial
Participants answered questions before and immediately after the workshop, then at six and 12 months. The researchers measured knowledge, perceived obstacles, intention to attend screening and self-reported attendance after an invitation. They used paired statistical comparisons and regression models to examine changes and associations.
The design followed participants over time, which is useful for assessing whether changes lasted beyond the day of the workshop. But there was no random assignment to a workshop versus a control condition. Participants volunteered, and the same individuals knew the programme was intended to encourage screening. That makes it impossible to isolate the workshop from other influences, including wider health campaigns, subsequent medical advice or changes in personal circumstances.
The sample also became smaller for some follow-up comparisons. The published knowledge table labels the immediate comparison as n = 169, with 103 at six months and 118 at 12 months. Its participant flowchart, however, reports fewer completed immediate post-workshop surveys, so the precise paired denominator for that first comparison is not entirely clear. The analysis of particular barriers used a smaller set of women who completed all four surveys. Each percentage therefore needs to be read with its own denominator.
Knowledge scores rose and stayed higher
The clearest finding was an improvement in factual knowledge. On the combined 14-point test covering the three cancers and their screening programmes, the average score increased from 3.1 at baseline to 7.3 immediately after the workshop. The mean paired increase was 4.2 points, with a 95% confidence interval from 3.6 to 4.8 points and a reported p-value below 0.001.
Among 103 participants assessed at six months, the mean score rose from 3.3 at their baseline assessment to 7.6. Among 118 assessed at 12 months, it rose from 3.2 to 7.4. Both follow-up comparisons showed a mean increase of 4.2 points. These are comparisons within the participants who completed each assessment, not evidence that every original attendee retained the same gain.
Looking at the separate components at 12 months, breast cancer knowledge increased from 1.6 to 3.4 on a six-point scale, a gain of 1.8. Cervical cancer knowledge increased from 1.1 to 2.7 on a five-point scale, a gain of 1.7. Bowel cancer knowledge increased from 0.6 to 1.3 on a three-point scale, a gain of 0.7. All three comparisons had reported p-values below 0.001.
These improvements are meaningful as educational outcomes, but they should not be confused with cancer prevention or early diagnosis. The workshop did not test whether participants developed fewer cancers or had better survival. It assessed knowledge and reported behaviour during the subsequent year.
Intentions to attend screening increased across all three programmes
Among 100 women with paired cervical-screening intention data at 12 months, the share saying they intended to attend at the next invitation rose from 43% to 83%. The reported increase was 40 percentage points, with a 95% confidence interval from 29 to 51 points.
For breast screening, intention increased from 55% to 92% among 38 women with the relevant paired responses, a rise of 37 percentage points. The 95% confidence interval was 22 to 52 points. For bowel screening, intention rose from 35% to 85% among 20 women, a 50-point increase with a much wider 95% confidence interval of 28 to 72 points.
The difference between these sample sizes matters. A 50-point rise in a group of 20 is encouraging, but more uncertain than a similar change measured in a much larger group. Also, intention is not attendance: someone can plan to attend screening but face an unexpected barrier when an invitation arrives.
What the study found about actual screening attendance
At 12 months, not every participant had received a screening invitation. That is partly because the national programmes operate on intervals longer than one year. The study therefore calculated self-reported uptake among women who said they had been invited, with some missing answers to the attendance question.
For breast screening, 22 women reported receiving an invitation, and 20 provided an answer about completion. Fourteen of those 20 said they attended, or 70%. For cervical screening, 50 women reported an invitation and 47 provided a completion answer. Forty-one of those 47 reported attending, or 87.2%. For bowel screening, 10 of 11 invited women reported completing the test, or 90.9%.
These distinctions resolve a denominator trap in the paper’s summary: 14 of 22 is not 70%, and 41 of 50 is not 87%. The reported percentages are calculated from respondents with non-missing completion data, as shown in the detailed results table. The figures should not be described as attendance rates among all 169 women.
Without a control group or verified health-service records, it is not possible to say how much of this attendance was attributable to the workshop. The investigators compared their results with broader UK screening statistics, but those national figures are not a matched comparison group with the same eligibility, recruitment and follow-up conditions.
Several barriers changed, while others barely moved
In a smaller paired analysis of screening concerns, the proportion agreeing that screening was unnecessary without symptoms fell from 43% to 22%. Agreement that a bowel screening kit was too messy fell from 67% to 38%, and the share finding the kit too difficult fell from 55% to 35%.
The share saying they had more important things to worry about than screening declined from 40% to 16%. Reported difficulty obtaining an appointment fell from 62% to 42%. These findings are consistent with the workshop addressing practical confusion as well as risk perceptions, although the absence of a control group limits causal interpretation.
Not every concern improved. Worry about cervical screening being painful remained at 67% in the relevant paired subgroup. Concern about having a male clinician did not decline: it was 80% before the workshop and 87% afterwards, a difference that was not statistically distinguishable from zero. Worry about costs and concerns about showing too much skin also showed no clear change.
The authors reported multiple exploratory comparisons without adjusting the p-values for all the tests. Some apparently significant changes could therefore reflect chance. The larger pattern is still informative: an educational workshop may address misunderstanding about symptoms and test kits while leaving some deeply practical or personal preferences intact.
Why information and access have to work together
The study’s regression analysis found that greater increases in cancer knowledge were associated with reductions in perceived screening barriers. After adjustment for baseline barrier scores and education, each additional point of knowledge improvement was associated with a 1.61-point decrease in the barrier score, with a 95% confidence interval from a 0.81- to a 2.41-point decrease.
A separate model of cervical screening uptake found associations with knowledge gains, barrier reductions and location. However, the location estimate was extremely imprecise, with an odds ratio of 121.3 and a confidence interval from 2.36 to 294,639.52. Such a wide interval signals that the small dataset cannot support a stable estimate of the size of a geographic difference.
These models do not establish that learning caused attendance. People who are already more motivated may pay closer attention, retain more information and be more willing to seek an appointment. Larger randomised studies would be needed to distinguish these possibilities.
What community co-design contributed
One notable feature of IMCAN is that local women helped shape the intervention rather than being treated only as recipients of a finished message. Community recruitment leads helped recruit participants, and 15 peer facilitators were trained to support delivery. The team also used community involvement to review survey materials and interpret findings.
This approach can make information more relevant and easier to discuss. Participants could ask a female GP questions, hear from women with similar experiences and discuss screening in terms that respected their own values. The study does not tell us which component mattered most, because everyone received the combined workshop.
That uncertainty is important for scalability. A programme requiring a clinician, peer facilitators and a religious scholar may be harder to reproduce than a standard leaflet. The authors suggested possible hybrid models, including trained community educators supported by a clinician online, but those alternatives were not experimentally evaluated here.
Screening technology is only one part of the problem
Much cancer research focuses on better tests, earlier detection and improved accuracy. For example, a separate Research Today report on a blood test for high-risk colorectal polyps examined the technical performance of a possible detection approach.
IMCAN addresses a different part of the same public-health challenge: even an effective test cannot benefit someone who does not understand the invitation, cannot arrange attendance or finds the process unacceptable. Improving detection technology and improving access are complementary goals, not competing ones.
The study may also interest health services outside Britain, including those serving multilingual or underserved communities. Its exact intervention, however, was tailored to UK screening schedules, local Muslim communities and a particular set of healthcare pathways. The numerical findings should not be transferred directly to other countries or populations.
Important limitations before treating this as a success story
The most consequential limitation is the lack of a control group. This was a non-randomised feasibility study, so it cannot establish that the workshop itself produced the changes. Recruitment through community networks and voluntary attendance may also have favoured women already open to learning about screening.
Follow-up was incomplete, and not all women were eligible for all three tests. The smallest screening groups produce wide uncertainty, especially for bowel screening. Reported uptake relied on participants’ answers rather than national health-service records, and the researchers acknowledged that people can overreport socially desirable health behaviour.
The workshop’s purpose was known to participants, which may have influenced survey responses. Many outcomes and barriers were tested, with no comprehensive multiple-comparison adjustment. Finally, 12 months is shorter than the invitation interval for several screening programmes, so many participants could not yet have had the opportunity to act.
The appropriate next step is a larger randomised trial with a suitable comparison group, longer follow-up and independently verified screening attendance. Such a trial could also compare different delivery formats and identify which parts of the programme are essential.
The bigger lesson
The study offers a practical reminder that informed screening decisions depend on more than medical facts. Participants showed sustained improvements in knowledge and reported stronger intentions after an intervention built with their community. At the same time, some concerns did not shift, and attendance could not be causally attributed to the workshops.
For health services, the defensible takeaway is not that faith-based workshops have been proven to increase cancer screening. It is that community-designed, multilingual and practical education deserves more rigorous testing as one possible way to reduce preventable gaps in access.
Source Information
Journal: Frontiers in Public Health.
Study: Peer-led, faith-based co-designed intervention to improve Muslim women’s cancer screening: results from the IMCAN study.
Authors: Floor Christie-De Jong, Rawand Jarrar, Aasim I. Padela, P. Theo Pepler, Marie K. Murphy, Alex McConnachie, Cerysh Sadiq, Fozia Haider, Anna Matthews, Laura A. V. Marlow and Kathryn A. Robb.
Published: 9 October 2026.
DOI: 10.3389/fpubh.2026.1918791.
Study design: Non-randomised, community-based pre-post feasibility and efficacy study, with follow-up at six and 12 months.
Sample and setting: 169 eligible Muslim women in Glasgow and North East England, UK, participating in 16 workshops in 2024.
