Self‐collection cervical screening in the renewed National Cervical Screening Program: a qualitative study

Abstract

Objectives To evaluate the implementation and acceptability of the self‐collection cervical screening pathway since commencement of the renewed National Cervical Screening Program (rNCSP), from the perspectives of screening participants and primary care practitioners. Design, setting, participants Qualitative study; individual semi‐structured interviews with 45 screening participants and 18 primary care practitioners in Victoria who had engaged with the self‐collection pathway during the first 17 months of the rNCSP (1 December 2017 ‒ 30 April 2019). Results The self‐collection pathway was highly acceptable as an alternative cervical screening pathway for most participating screening participants and practitioners. Some screening participants indicated that they would not have been screened had the pathway not been available. Acceptability was lower among those who had tested positive for HPV types not 16/18, a result that requires additional testing of a clinician‐collected cervical sample. Use of the self‐collection pathway is driven more by practitioners than their patients. Interpretations of the self‐collection guidelines varied between practices. Barriers to expanding promotion of the pathway by practitioners included difficulties with identifying eligible participants. Conclusions Increasing the accessibility of the self‐collection pathway to under‐ and never screened women could reduce inequities in cervical cancer outcomes for those not participating in the main screening pathway. Practitioners should be provided resources to integrate self‐collection into routine practice and to efficiently implement the entire self‐collection pathway, in order to maximise its use and to optimise the experience for screening participants.

The experience of under-screened and never-screened participants using clinician-supported self-collection cervical screening within the Australian National Cervical Screening Program

“…However, as described previously, 32 a small proportion of participants who tested positive for HPV, and required additional an additional clinician-collected cervical screening test, reported mixed acceptability of self-collection. This was not because of their experience of the self-collection test itself, but due to their experience of the follow-up pathway: I submitted to another unwanted and very unpleasant smear [clinician-collected cervical screening test], accompanied by the same usual sources of distress.…”

“…As part of a broader evaluation, we have previously reported that, while practitioners and screening participants perceived the self-collection pathway to be a highly acceptable alternative screening modality, the implementation of the pathway was limited by the restrictive eligibility criteria, limited knowledge and awareness of the pathway and uncertainty among practitioners regarding the clinical practice guidelines. 32 This article further details the screening participants’ experience of the self-collection cervical screening pathway and describes the perspectives of under-screened participants as to why self-collection was a suitable and acceptable method of cervical screening.…”

Aboriginal and Torres Strait Islander women's views of cervical screening by self‐collection: a qualitative study

“…[33][34][35][36][37] Other Australian women have similarly reported a great sense of control from participating in selfcollection. 25 Women's concerns about self-collection were mostly centred on views that the cliniciancollected test would be more precise, proper and professional, and some women had a preference to continue seeing their HCP for screening. This strongly related to fears that women would collect the sample incorrectly or that they would hurt themselves.…”

“…21 While a growing body of research suggests that Aboriginal and Torres Strait Islander women find self-collection to be acceptable in research study settings, [22][23][24] self-collection has largely been underutilised in Australia. 25 A comprehensive understanding of the views of Aboriginal and Torres Strait Islander women regarding self-collection is needed to build and implement models that can support and maximise the uptake and benefit of self-collection. This study aimed to explore the perspectives of Aboriginal and Torres Strait Islander women in relation to self-collection, including the benefits and their concerns, their views on the process and the instructions, and how they felt the selfcollection process could be improved.…”

Facilitating uptake of cervical screening among Indigenous women to achieve equitable and timely elimination of cervical cancer

“…The recent recommendation to offer all women the option to use self-collection would also facilitate clearer and more open and elevated communication, and reduce some of the current barriers faced by women and providers [10] . Nevertheless, the findings of Moxham et al emphasise the need for appropriate support and information when self-collection is offered, not simply removal of existing barriers.…”