Strategies to Reach Marginalized Women for Cervical Cancer Screening: A Qualitative Study of Stakeholder Perspectives

Wood, Brianne; Lofters, Aisha; Vahabi, Mandana

doi:10.3747/co.25.3851

Cited by 16 publications

(26 citation statements)

References 37 publications

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“…Concerns around self-collection centred on the lack of accuracy, safety, and sterility of the swab. The lack of accuracy of the sample was the most prevalent concern [ 42 – 46 , 48 , 53 , 56 , 58 , 59 , 61 – 65 ]; some women, especially those familiar with the other cervical screening methods, wondered whether the self-collection sample was as reliable as the clinician-collected sample [ 42 ]. In one particular study, a woman made the distinction between vaginal and cervical samples noting that for “screening that works well and detects lesions in that capacity, you need to have a cervical sample.…”

Section: Resultsmentioning

confidence: 99%

“…In one particular study, a woman made the distinction between vaginal and cervical samples noting that for “screening that works well and detects lesions in that capacity, you need to have a cervical sample. A self-sample is not a cervical sample; it is a vaginal sample” (woman, Canada) [ 56 ]. The lack of confidence in self-collection samples and its accuracy stemmed from the perception of user error, the unfamiliarity due to the method’s novelty and the lack of knowledge about self-collection [ 46 , 48 , 49 , 58 , 61 , 64 ].…”

Section: Resultsmentioning

confidence: 99%

“…According to several studies, self-collection could have a significant impact on the patient-HCW relationship [ 43 , 47 , 56 , 58 , 60 , 61 , 64 ]. The concept of preserving the relationship was a prevalent theme and is two-pronged: preserving the ‘clinical’ relationship and preserving the ‘social’ relationship.…”

Section: Resultsmentioning

confidence: 99%

“…Some women emphasised the need to ‘preserve’ the relationship to ensure that they have access to clinical support during the self-collection procedure and could inquire about non-screening related matters [ 56 , 58 , 61 , 64 ]. There were concerns that self-collection could prevent such meaningful personal interactions [ 58 , 64 ]: “nothing can replace the person who has learned all this well, to whom we can ask questions and whom we trust” (woman, Switzerland) [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

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Self-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis

Camara¹,

Zhang²,

Lafferty

et al. 2021

BMC Public Health

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Background Cervical cancer is the fourth most common cancer affecting women worldwide, with 85% of the burden estimated to occur among women in low and middle-income countries (LMICs). Recent developments in cervical cancer screening include a novel self-collection method for the detection of oncogenic HPV strains in the collected samples. The purpose of this review is to synthesise qualitative research on self-collection for HPV-based testing for cervical screening and identify strategies to increase acceptability and feasibility in different settings, to alleviate the burden of disease. Methods This review includes qualitative studies published between 1986 and 2020. A total of 10 databases were searched between August 2018 and May 2020 to identify qualitative studies focusing on the perspectives and experiences of self-collection for HPV-based cervical screening from the point of view of women, health care workers and other key stakeholders (i.e., policymakers). Two authors independently assessed studies for inclusion, quality, and framework thematic synthesis findings. The Socio-Ecological Model (SEM) was used to synthesize the primary studies. Results A total of 1889 publications were identified, of which 31 qualitative studies were included. Using an adapted version of SEM, 10 sub-themes were identified and classified under each of the adapted model’s constructs: (a) intrapersonal, (b) interpersonal, and (c) health systems/public policy. Some of the themes included under the intrapersonal (or individual) construct include the importance of self-efficacy, and values attributed to self-collection. Under the intrapersonal construct, the findings centre around the use of self-collection and its impact on social relationships. The last construct of health systems focuses on needs to ensure access to self-collection, the need for culturally sensitive programs to improve health literacy, and continuum of care. Conclusion This review presents the global qualitative evidence on self-collection for HPV-based testing and details potential strategies to address socio-cultural and structural barriers and facilitators to the use of self-collection. If addressed during the design of an HPV-based cervical cancer screening testing intervention program, these strategies could significantly increase the acceptability and feasibility of the intervention and lead to more effective and sustainable access to cervical screening services for women worldwide.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Self-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis

Camara¹,

Zhang²,

Lafferty

et al. 2021

BMC Public Health

View full text Add to dashboard Cite

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“…Current cervical screening programs are used for detecting premalignant lesions to prevent invasive cervical cancer (3). Since the screening programs have been established, cervical cancer incidence rates have decreased by as much as 80% over the past 40 years in several Western countries (4,5).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Cervical Cytopathological Diagnosis Using Innovative Qi Brush and Traditional Cervex-Brush® Combi

Zou

Tuo

et al. 2020

Front. Med.

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Objectives: To compare the effectiveness between Qi brush and Cervex-Brush ® Combi for the diagnosis of cervical lesions. Methods: After we registered a random-control clinical trial on the Chinese Clinical Trial Registry (No. XJTU1AF2017LSK-25), cervical cell samples were successively collected with both Qi brush and Cervex-Brush ® Combi before undergoing colposcope. Colposcopy with biopsy was performed later. Histological diagnosis was regarded as the gold standard in this study. The following indices of the two brushes were compared: sampling degree of satisfaction and presence rate of metaplastic cells, together with sensitivity (Se), specificity (Sp), false positives (FP), false negatives (FN), positive predictive value (PPV), and negative predictive value (NPV). The kappa value was used to measure the inter-rater agreement of the Qi brush and Cervex-Brush ® Combi in diagnosing cervical lesions. Results: In total, 74 patients were enrolled in this study. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Qi brush were 57.14, 86.84, 76.19, and 73.33%, respectively. For the Cervex-Brush ® Combi, they were 26.92, 88.89, 63.63, and 62.75%, respectively. In addition, the Qi brush had a higher satisfied sampling rate (89.19%) than the Cervex-Brush ® Combi (83.78%), and the P-value was 0.336 using Chi-square test. The kappa value was 0.444, which indicated a medium agreement between these two brushes, and the sensitivity of the Qi brush was higher than that of the Cervex-Brush ® Combi, with significant statistical difference (P = 0.039<0.05). Conclusions: The Qi brush was more effective than the Cervex-Brush ® Combi for sampling and also had a slightly higher accuracy in diagnosing in cytology. In terms of social and economic benefits, the Qi brush may be a better cervical cytology collector.

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Widening the offer of human papillomavirus self‐sampling to all women eligible for cervical screening: Make haste slowly

Sargent

Njor

Cuschieri

2022

Intl Journal of Cancer

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Self-collection of samples for human papillomavirus (HPV) testing has the potential to increase the uptake of cervical screening among underscreened women and will likely form a crucial part of the WHO's strategy to eliminate cervical cancer by 2030. In high-income countries with long-standing, organised cervical screening programmes, self-collection is increasingly becoming available as a routine offer for women regardless of their screening histories, including under-and well-screened women. For these contexts, a validated microsimulation model determined that adding self-collection to clinician collection is likely to be cost-effective on the condition that it meets specific thresholds relating to (1) uptake and (2) sensitivity for the detection of high-grade cervical intraepithelial neoplasia (CIN2+).We used these thresholds to review the 'early-adopter' programme-level evidence with a mind to determine how well and how consistently they were being met. The available evidence suggested some risk to overall programme performance in the situation where low uptake among underscreened women was accompanied by a high rate of substituting clinician sampling with self-collection among well-screened women. Risk was further compounded in a situation where the slightly reduced sensitivity of self-sampling vs clinician sampling for the detection of CIN2+ was accompanied with lack of adherence to a followup triage test that required a clinician sample. To support real-world programmes on their pathways toward implementation and to avoid HPV self-collection being introduced as a screening measure in good faith but with counterproductive consequences, we conclude by identifying a range of mitigations and areas worthy of research prioritisation.

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Strategies to Reach Marginalized Women for Cervical Cancer Screening: A Qualitative Study of Stakeholder Perspectives

Abstract: Background Self-sampling for human papillomavirus (hpv) has the potential to reach marginalized populations

Cited by 16 publications

References 37 publications

Self-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis

Self-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis

Comparison of Cervical Cytopathological Diagnosis Using Innovative Qi Brush and Traditional Cervex-Brush® Combi

Widening the offer of human papillomavirus self‐sampling to all women eligible for cervical screening: Make haste slowly

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