Women’s experience with home-based self-sampling for human papillomavirus testing

Abstract

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.

Assessing Acceptability of Self-Sampling Kits, Prevalence, and Risk Factors for Human Papillomavirus Infection in American Indian Women

“…This result demonstrates the feasibility of self-collection among Hopi women. As in other studies, most women reported positive attitudes toward self-sampling [6, 8, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40], with almost all reporting that the test was easy to use, and that they would recommend it to a friend or relative. A minority reported discomfort.…”

“…Most previous studies have also reported that a majority of participating women preferred self-sampling [6, 8, 24, 25, 27, 29, 30, 31, 35, 36, 37, 38], although some have returned the opposite finding [26, 28, 34, 39]. In our study, a higher proportion of women who were not adherent to Pap screening, relative to adherent women, preferred self-testing over clinician testing.…”

“…Reasons for non-participation in Pap screening are multifactorial, and include lack of insurance, inconvenience, difficulty finding childcare or taking time off work, lack of transportation, fear or embarrassment related to receiving a pelvic exam or an abnormal result, limited knowledge of cervical cancer, cultural attitudes, and negative experiences with medical care [5, 6, 7, 8]. Many of these barriers could be addressed by offering opportunities for non-clinic-based cervical cancer screening.…”

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

“…Self-collected cervical samples receiving hpv testing show comparable cin2+ sensitivity compared with clinician-collected samples tested with cytology and with hpv 10-12 . Self-collection has proven to be highly acceptable among women 13 .…”

“…Some women, particularly those who have experienced abuse 14 or are otherwise marginalized, may find self-sampling preferable because of such things as cultural/religious embarrassment or discomfort associated with a pelvic exam 13,[15][16][17] . Time, transportation, inconvenient clinic hours, or not having a regular practitioner are also relevant factors associated with under-screening that can be mitigated through hpv self-collection using mailed samples 13,16,17 . However, there are psychosocial barriers to hpv screening, including women's lack of awareness and fears around hpv and cervical cancer screening, which cannot be addressed through self-collection-based screening alone 17,18 .…”