{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:57:49Z","timestamp":1791395869538,"version":"4.3.3"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["G0A7H24N"],"award-info":[{"award-number":["G0A7H24N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical cancer remains a global health burden despite being largely preventable through vaccination, screening, and timely treatment. Delays in follow-up after abnormal screening undermine the effectiveness of organized cervical cancer screening programmes. In Flanders (Belgium), organized screening and reminder systems exist, yet 17.7% of women do not receive adequate follow-up after an abnormal Pap smear, highlighting the need to understand multilevel factors influencing timely follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between September and November 2025, 14 semi-structured group interviews were conducted in person with 120 general practitioners and gynaecologists responsible for cervical cancer screening in Flanders. Interviews were audio-recorded, transcribed verbatim, and analysed in MaxQDA, using iterative thematic analysis combining deductive multilevel framework coding with inductive insights. Interviews were double-coded, with discrepancies resolved through discussion. Data collection and analysis proceeded concurrently until saturation and findings were validated with stakeholders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Despite the organized screening programme, healthcare providers experience cervical cancer screening follow-up as a complex, fragmented, and non-standardized multi-step pathway. Delays were mainly attributed to provider- and system-level factors, including inconsistent communication, challenges in interdisciplinary responsibilities and collaboration, high workload, and poorly integrated digital systems. Patient-related factors, such as language barriers and health literacy played a secondary role. Current follow-up processes were described as relying heavily on individual provider initiative rather than on well-coordinated, system-level structures. To improve timely follow-up, healthcare providers recommended standardised and proactive communication, clearer task allocation and responsibility, better integrated digital systems, the optimisation of the existing reminder mechanism and enhanced patient education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Delays in follow-up primarily reflect organisational and system-level weaknesses. Standardization, integrated digital systems, and clarified roles and responsibilities are key to reducing preventable delays. A \u201cdouble safety net\u201d combining provider oversight with informed patient involvement, alongside greater primary care engagement, may further enhance the continuity and timeliness of follow-up care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0359860","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:27:41Z","timestamp":1791394061000},"page":"e0359860","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Untimely follow-up after cervical cancer screening: A qualitative study among healthcare providers in Flanders (Belgium)"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8491-7768","authenticated-orcid":true,"given":"Marie","family":"Hendrickx","sequence":"first","affiliation":[{"name":"CAPHRI, Care and Public Health Research Institute, Maastricht University","place":["Maastricht, The Netherlands"],"department":["Department of Health Promotion"]},{"name":"Ghent University","place":["Ghent, Belgium"],"department":["Department of Public Health and Primary Care"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laure-Anne","family":"Kerckhaert","sequence":"additional","affiliation":[{"name":"Ghent University","place":["Ghent, Belgium"],"department":["Department of Public Health and Primary Care"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Willems","sequence":"additional","affiliation":[{"name":"Ghent University","place":["Ghent, Belgium"],"department":["Department of Public Health and Primary Care"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3731-6610","authenticated-orcid":true,"given":"Rik","family":"Crutzen","sequence":"additional","affiliation":[{"name":"CAPHRI, Care and Public Health Research Institute, Maastricht University","place":["Maastricht, The Netherlands"],"department":["Department of Health Promotion"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Verbestel","sequence":"additional","affiliation":[{"name":"CAPHRI, Care and Public Health Research Institute, Maastricht University","place":["Maastricht, The Netherlands"],"department":["Department of Health Promotion"]},{"name":"NUTRIM, Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University","place":["Maastricht, The Netherlands"],"department":["Department of Health Promotion"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrien","family":"Vanthomme","sequence":"additional","affiliation":[{"name":"Ghent University","place":["Ghent, Belgium"],"department":["Department of Public Health and Primary Care"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"issue":"2","key":"pone.0359860.ref001","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(19)30482-6","article-title":"Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis","volume":"8","author":"M Arbyn","year":"2020","journal-title":"Lancet Glob Health"},{"key":"pone.0359860.ref002","unstructured":"Belgian Cancer Registry. 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