BackgroundIncreasing cervical screening coverage by reaching inadequately screened groups is essential for improving the effectiveness of cervical screening programs. Offering HPV self-sampling to women who are never or under-screened can improve screening participation, however participation varies widely between settings. Information on women’s experience with self-sampling and preferences for future self-sampling screening is essential for programs to optimize participation.MethodsThe survey was conducted as part of a larger trial (“iPap”) investigating the effect of HPV self-sampling on participation of never and under-screened women in Victoria, Australia. Questionnaires were mailed to a) most women who participated in the self-sampling to document their experience with and preference for self-sampling in future, and b) a sample of the women who did not participate asking reasons for non-participation and suggestions for enabling participation. Reasons for not having a previous Pap test were also explored.ResultsAbout half the women who collected a self sample for the iPap trial returned the subsequent questionnaire (746/1521). Common reasons for not having cervical screening were that having Pap test performed by a doctor was embarrassing (18 %), not having the time (14 %), or that a Pap test was painful and uncomfortable (11 %). Most (94 %) found the home-based self-sampling less embarrassing, less uncomfortable (90 %) and more convenient (98 %) compared with their last Pap test experience (if they had one); however, many were unsure about the test accuracy (57 %). Women who self-sampled thought the instructions were clear (98 %), it was easy to use the swab (95 %), and were generally confident that they did the test correctly (81 %). Most preferred to take the self-sample at home in the future (88 %) because it was simple and did not require a doctor’s appointment. Few women (126/1946, 7 %) who did not return a self-sample in the iPap trial returned the questionnaire. Their main reason for not screening was having had a hysterectomy.ConclusionsHome-based self-sampling can overcome emotional and practical barriers to Pap test and increase participation in cervical screening despite some women’s concerns about test accuracy. Mailing to eligible women and assuring women about test accuracy could further optimize participation in screening.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1804-x) contains supplementary material, which is available to authorized users.

Objective-To assess the extent to which smokers and non-smokers in Victoria, Australia attempt to keep their homes smoke free and to determine whether the proportion of people attempting to do so has changed over time. Indoor restrictions on smoking were associated with the presence of children in the household and even more strongly with the presence of non-smoking adults. People who worked in places where smoking was totally banned were more likely to ask their visitors not to smoke than those who worked where smoking was allowed. Conclusions-The results indicate a strong move towards homes and towards protecting children from smoke. EVorts to support and facilitate this social change should be further encouraged. (Tobacco Control 1999;8:266-271)

We conducted a randomized controlled trial to determine whether HPV self-sampling increases participation in cervical screening by never-and under-screened (not screened in past 5 years) women when compared with a reminder letter for a Pap test. Never-or under-screened Victorian women aged 30-69 years, not pregnant and with no prior hysterectomy were eligible. Within each stratum (never-screened and under-screened), we randomly allocated 7,140 women to self-sampling and 1,020 to Pap test reminders. The self-sampling kit comprised a nylon tipped flocked swab enclosed in a dry plastic tube. The primary outcome was participation, as indicated by returning a swab or undergoing a Pap test; the secondary outcome, for women in the self-sampling arm with a positive HPV test, was undergoing appropriate clinical investigation. The Roche CobasV R 4800 test was used to measure presence of HPV DNA. Participation was higher for the self-sampling arm: 20.3 versus 6.0% for never-screened women (absolute difference 14.4%, 95% CI: 12.6-16.1%, p < 0.001) and 11.5 versus 6.4% for under-screened women (difference 5.1%, 95% CI: 3.4-6.8%, p < 0.001). Of the 1,649 women who returned a swab, 45 (2.7%) were positive for HPV16/18 and 95 (5.8%) were positive for other high-risk HPV types. Within 6 months, 28 (62.2%) women positive for HPV16/18 had colposcopy as recommended and nine (20%) had cytology only. Of women positive for other high-risk HPV types, 78 (82.1%) had a Pap test as recommended. HPV self-sampling improves participation in cervical screening for neverand under-screened women and most women with HPV detected have appropriate clinical investigation.The effectiveness of organized screening for cervical cancer is compromised by nonparticipation as the majority of cervical cancers arise in women who are either never-or underscreened, 1 including in Victoria, Australia. 2 Barriers to women's participation are well documented and commonly relate to fear of the speculum examination, lack of time or access, not finding the right doctor, or a previous negative experience. 3,4 Strategies that overcome such barriers and improve participation, particularly by engaging hard to reach groups, are imperative to improve coverage of cervical screening programs.HPV testing is likely to replace Pap testing in many highincome countries, including Australia, in the near future. 5 One advantage of HPV testing is that it can be done on selfcollected samples. 6 Although HPV testing of self-collected samples is slightly less sensitive and less specific than HPV testing of practitioner-collected samples unless a validated Polymerase Chain Reaction (PCR) test is used, it has the potential to overcome some of the barriers to conventional screening and facilitate participation by women who would not otherwise participate. 7,8 A recent systematic review and meta-analysis of sixteen randomized trials conducted in various countries showed that self-sampling increased participation in cervical cancer screening by non-attendees compared with a reminder to ha...

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Low socio-economic status (SES) has been associated with lower cervical screening rates. Mass media is one known strategy that can increase cervical screening participation. This study sought to determine whether a mass media campaign conducted in Victoria, Australia, in 2005 was effective in encouraging women across all SES groups to screen. Data were obtained from the Victorian Cervical Cytology Registry for each Pap test registered during 2005 and categorized into SES quintiles using the Index of Socio-Economic Advantage/Disadvantage. Negative binomial regression was used to determine the impact of the campaign on the weekly number of Pap tests and whether the media campaign had a differential effect by SES, after adjusting for the number of workdays per week, age group and time since previous test. Cervical screening increased 27% during the campaign period and was equally effective in encouraging screening across all SES groups, including low-SES women. Mass media campaigns can prompt increased rates of cervical screening among all women, not just those from more advantaged areas. Combining media with additional strategies targeted at low-SES women may help lessen the underlying differences in screening rates across SES.