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In Indiana, Black women had 12% higher cervical cancer incidence, and 21% higher mortality compared to White women during the years 2008–2017. Human Papillomavirus (HPV) self-sampling delivered by community health workers (CHW) has demonstrated potential to increase cervical cancer screening rates among at-risk populations. This study aims to understand patient attitudes toward HPV self-sampling and CHW-delivered screening.
Methods:
We conducted a cross-sectional online survey among patients from three Planned Parenthood clinics in Lake County, IN, which has one of the highest cervical cancer mortality rates in Indiana. Patients’ willingness to self-sample and to receive health education and services related to cervical cancer screening from CHWs was analyzed using logistic regression.
Results:
In the final sample (N = 140), the largest proportions of respondents were below age 30 (54.3%), aware of cervical cancer (78.6%), up to date on cervical cancer screening (84.3%), had no prior self-sampling experience (53.6%) and were aware of CHWs (52.1%). Multivariable logistic regression analyses showed Black patients had higher odds of being willing to: self-sample at home (aOR = 3.749, 95% CI = 1.619–8.681), receive health education from CHWs (aOR = 4.952, 95% CI = 2.124–11.548), and receive health services from CHWs (aOR = 3.305, 95% CI = 1.479–7.388) compared to White patients.
Conclusion:
Our results showed Black patients had higher willingness for HPV self-sampling and CHW delivery of cervical cancer screening services. Study findings can be used to inform future CHW-led interventions for outreach, education, and delivery of self-sampling interventions to increase cervical cancer screening rates among Black women in underserved areas.
Cervical cancer screening rates in the USA fall behind national targets, requiring innovation to circumvent screening barriers. Cervical cancer screening where human papillomavirus (HPV) testing is performed on vaginal samples collected by the patients themselves (self-sampling) are effective and acceptable, and patient-operated rapid HPV tests (self-testing) are currently under development. It is unclear why there is ambivalence toward HPV self-sampling and self-testing among clinicians, an important stakeholder group. We conducted a mixed convergent quantitative and qualitative study to identify the factors influencing clinicians’ attitudes toward self-sampling and self-testing.
Methods:
A survey of Midwest clinicians distributed by professional group media and a market research firm between May and November 2021 was analyzed (n = 248) alongside in-depth interviews with Midwest clinicians from professional groups (n = 23). Logistic regression models examined willingness to support self-sampling and self-testing across respondent characteristics.
Results:
We report that family practice physicians and those in rural areas were more willing to adopt HPV self-sampling (adjusted OR (aOR) = 3.16 [1.43–6.99]; aOR = 2.17 [1.01–4.68]). Clinician willingness to support self-testing was positively associated with current use of self-testing for other conditions and negatively associated with performing 10 or more monthly cervical cancer screenings (aOR = 2.02 [1.03–3.95], aOR = 0.42 [0.23–0.78]). Qualitative data contextualize how clinical specialty and experience with self-sampling and self-testing for other conditions inform clinician perspectives.
Conclusion:
These data suggest clinician populations most accepting of initiatives to implement self-sampling and self-testing for cervical cancer screening and highlight that experience with other forms of self-testing could facilitate more widespread adoption for cervical cancer.
Self-collection for cervical screening has been available in the Australian National Cervical Screening Program since 2017 and is now available to all people as an option for cervical screening through a practitioner-supported model. Documenting early adopting practitioner experiences with self-collection as a mechanism to engage people in cervical screening is crucial to informing its continuing roll-out and implementation in other health systems.
Aim:
This study aimed to describe the experiences of practitioners in Victoria, Australia, who used human papillomavirus (HPV)-based self-collection cervical screening during the first 17 months of its availability.
Methods:
Interviews (n = 18) with practitioners from Victoria, who offered self-collection to their patients between December 2017 and April 2019, analysed using template analysis.
Findings:
Practitioners were overwhelmingly supportive of self-collection cervical screening because it was acceptable to their patients and addressed patients’ barriers to screening. Practitioners perceived that knowledge and awareness of self-collection were variable among the primary care workforce, with some viewing self-collection to be inferior to clinician-collected screening. Practitioners championed self-collection at an individual level, with the extent of practice-level implementation depending on resourcing. Concerns regarding supporting the follow-up of self-collected HPV positive patients were noted. Other practical barriers included gaining timely, accurate screening histories from the National Cancer Screening Register to assess eligibility. Practitioners’ role surrounded facilitating the choice between screening tests through a patient-centred approach.
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