Assessing women's willingness to collect their own cervical samples for HPV testing as part of the ASPIRE cervical cancer screening project in Uganda

Mitchell, Sheona; Ogilvie, Gina; Steinberg, Malcolm; Sekikubo, Musa; Biryabarema, Christine; Money, Deborah

doi:10.1016/j.ijgo.2011.01.028

Cited by 77 publications

(117 citation statements)

References 17 publications

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“…The top concerns found in the present study are consistent with findings from previous research in multiple settings suggesting that women may be concerned about pain or injury,15 34 35 failing to self-collect an adequate sample, and the reliability or accuracy of a self-collected sample compared to one collected by a clinician 15 35 36. Programmes implementing self-collected samples may be able to address these concerns.…”

Section: Discussionsupporting

confidence: 88%

“…Qualitative research among Malawian women found that cervical cancer knowledge was limited and thus this may be an important place to intervene to increase screening 33. In line with our findings on the importance of perceived behavioural control, a study among urban Ugandan women that also utilised the TPB similarly found that perceived behavioural control was associated with increased willingness to self-collect,34 thus screening programmes may benefit from building women's skills and confidence in their ability to self-collect samples.…”

Section: Discussionsupporting

confidence: 84%

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Factors influencing Malawian women's willingness to self-collect samples for human papillomavirus testing

Esber

McRee

Turner

et al. 2016

J Fam Plann Reprod Health Care

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Background Malawi has the highest incidence of cervical cancer in the world. Only 3% of Malawian women have ever been screened for cervical cancer. Self-collection of samples for human papillomavirus (HPV) testing could increase screening among under-screened and hard-to-reach populations. However, little is known about the acceptability of self-collection in rural African settings. Aim We aimed to characterize Malawian women's willingness to self-collect vaginal samples for HPV testing and to identify potential barriers. Design We used data from the baseline wave of a community-based cohort study, collected from July 2014 – February 2015. Setting Participants were enrolled from the catchment area of a clinic in rural Lilongwe District, Malawi. Methods We enrolled women ages 15 - 39 years (n=824). Participants answered questions assessing willingness to self-collect a sample for HPV testing, concerns about testing and other hypothesized correlates of willingness to self-collect. Results Two-thirds of women (67%) reported willingness to self-collect a vaginal sample in their homes. Awareness of cervical cancer, supportive subjective norms, perceived behavioral control, and clinician recommendations were all positively associated with increased willingness to self-collect samples for HPV testing. Identified barriers to self-testing endorsed by women included: concerns that the test might hurt (22%), that they might not do the test correctly (21%), and that the test might not be accurate (17%). Conclusions This study suggests that self-collection for HPV testing could be an acceptable cervical cancer screening method in this rural population. Findings identify modifiable beliefs and barriers that can inform the development of effective screening programs.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 84%

Factors influencing Malawian women's willingness to self-collect samples for human papillomavirus testing

Esber

McRee

Turner

et al. 2016

J Fam Plann Reprod Health Care

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“…Until now, this collaboration has conducted a baseline survey to explore the acceptability of self-collected HPV DNA testing and attitudes towards cervical cancer screening26 27 as well as a feasibility study enrolling 200 women and taking them from HPV swab self-collection to colposcopy and treatment 28…”

Section: Context and Settingmentioning

confidence: 99%

Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda

et al. 2014

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ObjectiveTo define embarrassment and develop an understanding of the role of embarrassment in relation to cervical cancer screening and self-collected human papillomavirus (HPV) DNA testing in Uganda.DesignCross-sectional, qualitative study using semistructured one-to-one interviews and focus groups.Participants6 key-informant health workers and 16 local women, purposively sampled. Key informant inclusion criteria: Ugandan members of the project team. Focus group inclusion criteria: woman age 30–69 years, Luganda or Swahili speaking, living or working in the target Ugandan community. Exclusion criteria: unwillingness to sign informed consent.SettingPrimary and tertiary low-resource setting in Kampala, Uganda.ResultsIn Luganda, embarrassment relating to cervical cancer is described in two forms. ‘Community embarrassment’ describes discomfort based on how a person may be perceived by others. ‘Personal embarrassment’ relates to shyness or discomfort with her own genitalia. Community embarrassment was described in themes relating to place of study recruitment, amount of privacy in dwellings, personal relationship with health workers, handling of the vaginal swab and misunderstanding of HPV self-collection as HIV testing. Themes of personal embarrassment related to lack of knowledge, age and novelty of the self-collection swab. Overall, embarrassment was a barrier to screening at the outset and diminished over time through education and knowledge. Fatalism regarding cervical cancer diagnosis, worry about results and stigma associated with a cervical cancer diagnosis were other psychosocial barriers described. Overcoming psychosocial barriers to screening can include peer-to-peer education, drama and media campaigns.ConclusionsEmbarrassment and other psychosocial barriers may play a large role at the onset of a screening programme, but over time as education and knowledge increase, and the social norms around screening evolve, its role diminishes. The role of peer-to-peer education and community authorities on healthcare cannot be overlooked and can have a major impact in overcoming psychosocial and social barriers to screening.

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“…HPV testing has been suggested as primary screening in place of cytology in the US and Europe (Kitchener et al 2009;Cusick et al 2006) and a negative HPV test predicts a less than 2% risk of developing cervical dysplasia (Naucler et al 2009;Lonky et al 2010;Mesher et al 2010;Kitchener et al 2009;Cusick et al 2006). An advantage of HPV testing is that a pelvic exam is not required, but simply insertion of a swab into the vagina to obtain the sample; furthermore, studies have shown that accurate results can be obtained with self-testing, where the woman inserts the swab into her own vagina (Ogilvie et al 2005;Balasubramanian et al 2010), that this compares favorably to collection by clinicians (Bhatla et al 2009;Petignat et al 2007) and is acceptable to women (Mitchell et al 2011;Lack et al 2005). However, treatment of positive results clearly requires access to and good visualization of the cervix.…”

Section: Alternatives To Cervical Cytologymentioning

confidence: 99%

“…An advantage of HPV testing is that pelvic exam is not required, but simply insertion of a swab into the vagina to obtain the sample; furthermore, studies have shown that accurate results can be obtained with self-testing, where the woman insert the swab into her own vagina (Ogilvie et al 2005;Balasubramanian et al 2010), that this compares favorably to collection by clinicians (Bhatla et al 2009;Petignat et al 2007) and is acceptable to women (Mitchell et al 2011;Lack et al 2005). However, treatment of positive results clearly requires access to and good visualization of the cervix.…”

Section: Alternatives To Cervical Cytologymentioning

confidence: 99%

Cervical Cancer Screening and Prevention for HIV-Infected Women in the Developing World

Anderson¹,

Lu²,

Sanghvi³

et al. 2012

Cancer Prevention - From Mechanisms to Translational Benefits

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Assessing women's willingness to collect their own cervical samples for HPV testing as part of the ASPIRE cervical cancer screening project in Uganda

Abstract: Self-collection is an option in impoverished settings in Africa. To improve acceptability, women should be taught how to properly collect their own cervical sample and encouraged to find ways to make the collection less embarrassing.

Cited by 77 publications

References 17 publications

Factors influencing Malawian women's willingness to self-collect samples for human papillomavirus testing

Factors influencing Malawian women's willingness to self-collect samples for human papillomavirus testing

Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda

Cervical Cancer Screening and Prevention for HIV-Infected Women in the Developing World

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