Uptake and acceptability of human papillomavirus self-sampling in rural and remote Aboriginal communities: Evaluation of a nurse-led community engagement model

Abstract

Background Aboriginal women experience disproportionately higher rates of cervical cancer mortality yet are less likely to participate in screening for early detection. This study sought to determine whether a community-based HPV self-sampling service model can effectively recruit never-screened and under-screened Aboriginal women to participate in cervical cancer screening; assess the clinical outcomes; and explore the acceptability of the model from the perspective of the participants. Methods Aboriginal women aged 25-69 years of age were recruited from eight rural and remote communities in New South Wales, Australia to participate in HPV self-sampling via a community-based service model. Outcome measures were: number of women screened by HPV self-sampling, their prior cervical screening status (under-screened or never-screened), clinical outcomes and participation in follow-up pathways of care, and satisfaction with the service model. Results In total, 215 women conducted a HPV self-sampling test and 200 evaluation surveys were completed. One-fifth of participants (n=46) were never-screened and one-third (n=69) were under-screened. Many were unsure of their screening status. Nine women were HPV 16/18 positive and eight had completed all follow up by the conclusion of the study. A further 30 women were HPV other positive of which 14 had completed follow up at the conclusion of the study. Satisfaction with the HPV self-sampling kit, the process of self-sampling and the service model was high (>92% satisfied on all items). Many women had difficulty understanding their official HPV results and placed high importance on the nurse explaining it to them. Conclusions A community-based service model that respects Women’s Business can effectively recruit under-screened and never-screened Aboriginal women to complete cervical cancer screening. Furthermore, this service model supports them to complete recommended follow-up care and engage with their local existing health services.

Aboriginal and Torres Strait Islander women's views of cervical screening by self‐collection: a qualitative study

“…This strongly related to fears that women would collect the sample incorrectly or that they would hurt themselves. Overall, our study findings were consistent with research with Aboriginal and Torres Strait Islander women 23,24 and other Australian women 18,25,38,39 suggesting that self-collection is acceptable, although some women still hold reservations. 40,41 Internationally, other Indigenous women report similar benefits and concerns.…”

“…19,20 Self-collection may provide a mechanism to overcome some barriers to participation in cervical screening while enhancing women's sense of control and empowerment. 21 While a growing body of research suggests that Aboriginal and Torres Strait Islander women find self-collection to be acceptable in research study settings, [22][23][24] self-collection has largely been underutilised in Australia. 25 A comprehensive understanding of the views of Aboriginal and Torres Strait Islander women regarding self-collection is needed to build and implement models that can support and maximise the uptake and benefit of self-collection.…”

“…Self‐collection may provide a mechanism to overcome some barriers to participation in cervical screening while enhancing women's sense of control and empowerment 21 . While a growing body of research suggests that Aboriginal and Torres Strait Islander women find self‐collection to be acceptable in research study settings, 22-24 self‐collection has largely been underutilised in Australia 25 …”

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 selfcollected 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.…”