Reactions of women underscreened for cervical cancer who received unsolicited human papillomavirus self-sampling kits

Abstract

Objectives To evaluate experiences and reactions after receiving a mailed, unsolicited human papillomavirus self-sampling kit and identify psychosocial correlates of using kits. Methods Survey participants were underscreened women aged 30–64 who were mailed human papillomavirus kits as part of a pragmatic trial at Kaiser Permanente Washington, a United States integrated health care system. Six months after the mailing, we invited kit returners and non-returners to complete a web survey that measured psychosocial factors (e.g. cervical cancer/human papillomavirus knowledge, attitudes toward screening), experiences, and reactions to kits. We compared responses between kit returners and non-returners. Results Comparing 116 kit returners (272 invited) and 119 non-returners (1083 invited), we found no clinically significant differences in psychosocial factors. Overall, survey respondents showed knowledge gaps in human papillomavirus natural history (82% did not know human papillomavirus infection can clear on its own) and interpreting human papillomavirus test results (37% did not know a human papillomavirus-negative result indicates low cancer risk). Kit returners found kits convenient and easy to use (>90%). The most common reason for non-return was low confidence in ability to correctly use a kit, although many non-returners (49%) indicated that they would consider future use. Women reported low trust in human papillomavirus testing to identify women at high risk for cervical cancer (52% in returners, 42% in non-returners). Conclusions Screening programs could improve uptake and acceptability of human papillomavirus self-sampling through outreach materials that emphasize the high efficacy of human papillomavirus testing for cervical cancer screening and educate patients about how to interpret results.

Self-Sampling Devices for HPV Testing

“…In underscreened or never-screened populations, direct mail strategies have been shown to result in higher screening uptake, enabling access to people who have not engaged with the health care system in some time. 53 Sending self-testing kits to individuals' homes via direct mail can be more cost-effective than opt-in strategies, where individuals have to seek out testing themselves, although with higher overall costs. 27 In a systematic review of interventions to improve the uptake of cervical cancer screening among lower socioeconomic groups, population screening programs were, as a whole, unlikely to remove the barriers and socioeconomic inequalities that prevent many underscreened people from participating.…”

Leveraging COVID-era innovation for cervical cancer screening: Clinician awareness and attitudes toward self-sampling and rapid testing for HPV detection

“…Several studies and meta-analyses have found that, compared with clinician-collected samples, self-collected HPV samples showed high diagnostic accuracy [16][17][18]. Highly acceptable or even preferred among women over clinician-collected samples [19][20][21][22][23], HPV self-sampling has garnered attention for its potential to increase screening by circumventing barriers to the Pap smear, and ease of use outside of a clinic.…”

Strategies to Increase Cervical Cancer Screening With Mailed Human Papillomavirus Self-Sampling Kits

“…Our 2014-2017 HOME trial, which was embedded in a US health care system, found that mailing HPV self-sampling kits to underscreened individuals increased screening by 9% over usual care (26% vs 17%), similar to international trials . However, most individuals remained unscreened with low follow-up of HPV-positive results and patient understanding of testing …”

“…18,19 However, most individuals remained unscreened with low follow-up of HPV-positive results and patient understanding of testing. [18][19][20][21] As US health care systems introduce primary HPV screening with possible self-sampling, they need data to inform implementation. HPV self-sampling trials 22 have not specifically evaluated kit uptake among populations that are screeningadherent or have unknown screening history (where potential overscreening is a concern).…”