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

Abstract

Background: Australia has had significant successes in the prevention of cervical cancer. However, there is considerable scope for improving screening participation. In December 2017, Australia shifted from cytology to a human papillomavirus–based screening program as part of the renewed National Cervical Screening Program. This provided the opportunity to introduce a clinician-supported self-collection cervical screening pathway, which allows screening participants aged 30 years or more and who are under-screened or never-screened to screen via a self-collected human papillomavirus test. Objective: This study aimed to explore screening participant experiences of a clinician-supported self-collection cervical screening pathway. Methods: Interviews (n = 45) were conducted with participants who had used the clinician-supported self-collection cervical screening pathway in the Australian National Cervical Screening Program between December 2017 and April 2019. Interviews were analyzed using template analysis. Results: Under-screened and never-screened participants reported a variety of interrelated barriers to cervical screening due to the nature of the test. For these participants, self-collection was a preferable way to perform screening as it overcame various barriers, was easy to use and promoted a sense of empowerment. Participants reported that the role of their practitioner was influential in their decision to undertake cervical screening, and that the support and information provided was a key factor in their experiences of the self-collection pathway. Conclusion: Findings support the use of a clinician-supported model of care, as an alternative screening modality in Australia’s National Cervical Screening Program. As more countries consider the move from a cytology to human papillomavirus–based cervical screening program, this model may assist in greater engagement of under-screened participants.

“So, if she wasn’t aware of it, then how would everybody else out there be aware of it?”—Key Stakeholder Perspectives on the Initial Implementation of Self-Collection in Australia’s Cervical Screening Program: A Qualitative Study

“…The implementation of self-collection is ongoing and experiences, and issues are likely to evolve over time, especially given the transition to universal access to self-collection. We also did not capture the experiences of screen eligible people who used self-collection: other studies have captured this within the Australian program [ 38 , 39 , 40 ]. Additional research documenting the implementation experience and evolution of these issues overtime, and how they are mitigated, is warranted.…”

Cancer survival differentials for Aboriginal and Torres Strait Islander peoples in Queensland: the impact of remoteness

“…Increasing cancer screening programs' cultural safety is critical to addressing survival inequities. The introduction of innovative new technology, such as the HPV self-collection method that will be universally available in Australia from 1 July 2022, holds great promise since it has been shown to be acceptable and increase cervical screening for under screened populations [42,43].…”

Health care system factors influencing primary healthcare workers’ engagement in national cancer screening programs: a qualitative study

“…Although there has previously been uncertainty around the sensitivity of a self‐collected swab, this has been addressed, with an updated meta‐analysis demonstrating test performance for self‐collected specimens to be equally sensitive to a clinician‐collected specimen 30 . Additionally, compelling evidence indicates that self‐collection can increase participation rates among under‐ and never‐screened individuals in the NCSP 31,32 and it has been demonstrated to be highly acceptable to both screening participants and practitioners 33,34 . The underlying beliefs of non‐adopting practitioners as identified in this study highlights the importance of regular and accurate knowledge dissemination to PHCWs in order to support the adoption of initiatives that aim to increase engagement with the screening programs.…”

“…30 Additionally, compelling evidence indicates that self-collection can increase participation rates among under-and never-screened individuals in the NCSP 31,32 and it has been demonstrated to be highly acceptable to both screening participants and practitioners. 33,34 The underlying beliefs of non-adopting practitioners as identified in this study highlights the importance of regular and accurate knowledge dissemination to PHCWs in order to support the adoption of initiatives that aim to increase engagement with the screening programs. Aligning with our findings, previous research has deemed that understanding the context and interplay between factors affecting intervention implementation as 'critical' to achieving change in primary health care.…”