Determinants for Participation in Human Papillomavirus Self-Sampling among Nonattenders to Cervical Cancer Screening in Denmark

Abstract

Offering human papillomavirus-based self-sampling to nonparticipants in routine cervical cancer screening can increase screening participation. However, little is known about characteristics of women who accept self-sampling. In this population-based study, we investigated determinants for participation in self-sampling among Danish nonattenders to routine cervical cancer screening. During 2014 to 2015, a random sample of screening nonparticipants ages 27 to 65 years living in the Capital Region of Denmark were invited for self-sampling. Of 21,314 eligible women, 4,743 participated in self-sampling. Information on sociodemographic characteristics and mental and physical health of all the women was obtained from nationwide registries, and 3,707 women completed a questionnaire on lifestyle, sexual behavior, and reasons for nonparticipation in routine screening. We used logistic regression to estimate ORs for participation in self-sampling, crude, and adjusted for sociodemographic characteristics. Basic education [OR = 0.79; 95% confidence interval (CI), 0.72-0.88], low income (OR = 0.66; 95% CI, 0.59-0.73), origin from a nonwestern country (OR = 0.43; 95% CI, 0.38-0.48), and being unmarried (OR = 0.66; 95% CI, 0.61-0.72) were associated with lower self-sampling participation. Long-term unscreened women (OR = 0.49; 95% CI, 0.45-0.53), women with prior schizophrenia or other psychoses (OR = 0.62; 95% CI, 0.48-0.80), women with poor self-perceived health (OR = 0.42; 95% CI, 0.25-0.69), and women who perceived screening as unnecessary (OR = 0.54; 95% CI, 0.37-0.80) or irrelevant (OR = 0.81; 95% CI, 0.78-0.96) were less likely to self-sample. Certain population groups, including women with low socioeconomic position or of nonwestern origin, were less likely to participate in self-sampling. Targeted approaches may be needed to increase screening participation in these groups.

<p>Non-Adherence To Childhood HPV Vaccination Is Associated With Non-Participation In Cervical Cancer Screening – A Nationwide Danish Register-Based Cohort Study</p>

“…Furthermore, in line with our interaction results regarding the influence of native background on HPV vaccination and subsequent screening, two recent Danish studies showed both lower attendance and lower effect size of offering HPV self-sampling to non-native women than to native women,54,55 supporting that health-promoting behavior may be influenced by nativity/region of origin.…”

Evaluation of p16/Ki‐67 dual‐stain as triage test for high‐risk HPV‐positive women: A hospital‐based cross‐sectional study

“…Sometimes women hesitate to participate in screening because of personal, practical, and financial reasons. 40 In conclusion, our study demonstrated that p16/ Ki-67 dual-stain test could achieve better performance compared with TCT examination for ≥CIN2 or ≥ CIN3 detection, representing a promising approach as a specific and efficient triage strategy for high-risk HPV-positive women.…”

“…All data were supplied by the laboratories, and women could not be tracked if they had moved to another screening provider. Sometimes women hesitate to participate in screening because of personal, practical, and financial reasons 40 …”

Experiences and preferences towards collecting a urine and cervicovaginal self-sample among women attending a colposcopy clinic

“…In order to increase the attendance rates, the Dutch Health Council recently advised to send self-sampling kits to all women invited for cervical screening, since this opt-out approach is considered to be more effective compared to the currently used opt-in approach ( Arbyn et al, 2018 , Dutch Health Council, 2021 ). However, this effect might be limited in women with a lower socio-economic status, women with a migration background, or women who have not attended cervical cancer screening for over ten years, because they are less prone to accept cervicovaginal self-sampling than the general population ( Harder et al, 2018 ). Furthermore, less trust and low self-efficacy expectations towards performing correct cervicovaginal self-sampling might explain why only 5–8% of women attending cervical cancer screening participate by the option of cervicovaginal self-sampling ( Integraal Kankercentrum Nederland, 2021 , Polman et al, 2019 , Williams et al, 2017 ).…”