Barriers to Acceptance of Self-sampling for Human Papillomavirus across Ethnolinguistic Groups of Women

Abstract

Objectives: Immigrant and low socio-economic (SES) women in North America underutilize Papanicolaou screening. Vaginal swab self-sampling for oncogenic human papillomavirus (HPV) has the potential to increase cervical cancer screening participation. The purpose of this qualitative study was to understand the perceptions of lower SES and immigrant women regarding self-sampling for HPV.Methods: Eleven focus-group interviews were conducted: one with Canadian-born English-speaking lower SES women, and two groups each with Arabic, Cantonese, Dari (Afghani), Somali and Spanish (Latino)-speaking women (one group conducted in English, the other in the native language) recently immigrated to Canada. Five to nine women aged 35 to 65 years and married with children participated in each group.Results: Themes included 1) who might use self-sampling and why; 2) aversion to self-sampling and reasons to prefer physician; 3) ways to improve the appeal of self-sampling. Women generally perceived benefits of self-sampling and a small number felt they might use the method, but all groups had some reservations. Reasons included: uncertainty over performing the sampling correctly; fear of hurting themselves; concern about obtaining appropriate material; and concerns about test accuracy. Women preferred testing by a health care professional because they were accustomed to pelvic examinations, it was more convenient, or they trusted the results.Conclusions: Perceptions of self-sampling for HPV were similar across cultures and pertained to issues of confidence in self-sampling and need for physician involvement in care. These findings can inform programs and studies planning to employ self-sampling as a screening modality for cervical cancer.

Women's Attitudes Toward Cervicovaginal Self-Sampling for High-Risk HPV Infection on the US-Mexico Border

“…A pair of studies, 22,23 one 23 done among women at high risk for cervical cancer and the other done within a large Mexican population, 22 reported self-sampling to be preferable over clinician testing due to less embarrassment and being more comfortable with the test. Contrary to most studies 16,18,28–30 that have shown that women preferred clinician-collected samples over self-sampling, we found that among participants who stated a preference for either test, self-sampling was more preferable. We did not find differences between tests in participants’ perception of test accuracy or participants’ perception that the test is performed correctly.…”

“…We did not find differences between tests in participants’ perception of test accuracy or participants’ perception that the test is performed correctly. Concerns about the accuracy of the test, 29 uncertainty over performing the test correctly 18,31 and fear of harm 18 had been the most commonly cited factors for participants not preferring self-sampling over cervical cytology testing in other settings. The difference between our finding and those of others may be due to providing education in which concerns were addressed before having participants collect their own cervico- vaginal samples.…”

“…13–15 Self-sampling has had high acceptability within diverse populations; 16–23 however, women have cited barriers to intention to use it such as low self-efficacy about performing self-sampling correctly, fear of self-harm, not having enough knowledge on the test, and the lack of confidence about the test’s accuracy. 16,18 …”

Self-collecting a cervico-vaginal specimen for cervical cancer screening: An exploratory study of acceptability among medically underserved women in rural Appalachia

“…Additionally, the data collected via baseline and follow-up interviews were primarily based on self-report. Previous studies have noted that women tend to overstate their participation in cervical cancer screenings [43]. There is also the possibility for selection bias as study participants were already seeking services at a healthcare clinic and may be more proactive in accepting cervical cancer screening.…”

Human Papillomavirus Self-Sampling in Cameroon

“…Anhang et al [19] observed among an urban population in New York City that, despite describing the self-HPV as easy to be used (67%) and not painful (67%), most of the women (68%) still preferred the physician sampling mainly because ''the doctor knew how to do the test correctly.'' Studies on women immigrated to Canada, the United Kingdom, or the United States reported 2 significant barriers to self-HPV, the women's concerns that they would not take the sample properly and their fear of experiencing pain [20,22,23]. Another Canadian study, performed on women from a primary care population, aged 15 to 49 years and accustomed to a routine physical examination and Pap smear, reported also that a significant proportion of women (54%) preferred physician sampling.…”