1. Epidemiology and Global Health

Perceived barriers to cervical cancer screening and motivators for at-home human papillomavirus self-sampling during the COVID-19 pandemic: Results from a telephone survey

  1. Susan Parker  Is a corresponding author
  2. Ashish A Deshmukh
  3. Baojiang Chen
  4. David R Lairson
  5. Maria Daheri
  6. Sally W Vernon
  7. Jane R Montealegre
  1. Baylor College of Medicine, United States
  2. Medical University of South Carolina, United States
  3. UTHealth School of Public Health, United States
  4. Harris Health System, United States
https://doi.org/10.7554/eLife.84664
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Cite this article
  1. Susan Parker
  2. Ashish A Deshmukh
  3. Baojiang Chen
  4. David R Lairson
  5. Maria Daheri
  6. Sally W Vernon
  7. Jane R Montealegre
(2023)
Perceived barriers to cervical cancer screening and motivators for at-home human papillomavirus self-sampling during the COVID-19 pandemic: Results from a telephone survey
eLife 12:e84664.
https://doi.org/10.7554/eLife.84664
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4 tables and 1 additional file

Tables

Table 1
Participant characteristics among a subgroup of PRESTIS trial participants randomized to receive a mailed self-sample kit for HPV testing who participated in a telephone survey between August 2020 and September 2022 (n=233).
Patient characteristicM (SEM)
Age (years)47.2 (0.62)
N (%)
30–39
40–49
50–59
60–65		59 (25.3%)
78 (33.5%)
69 (29.6%)
27 (11.6%)
N (%)
Language of InterviewEnglish90 (38.6%)
Spanish143 (61.4%)
Race/EthnicityHispanic162 (69.5%)
Black/African American51 (21.9%)
White14 (6.0%)
Asian3 (1.3%)
Other3 (1.3%)
Place of birthMexico92 (39.5%)
United States81 (34.8%)
Central America48 (20.6%)
South America4 (1.7%)
Asia2 (0.9%)
Europe3 (1.3%)
Other2 (0.9%)
Declined to answer1 (0.4%)
Total
(n=233)		English (n=90)Spanish
(n=143)
Education completed*No formal schooling4 (1.7%)0 (0%)4 (2.8%)
Some elementary15 (6.4%)0 (0%)15 (10.5%)
Elementary45 (19.3%)3 (3.3%)42 (29.4%)
Some high school41 (17.6%)13 (14.4%)28 (19.6%)
High school64 (27.5%)28 (31.1%)36 (25.2%)
Some college/vocational school33 (14.2%)21 (23.3%)12 (8.4%)
College/vocational school28 (12.0%)25 (27.8%)3 (2.1%)
Declined to answer3 (1.3%)0 (0%)3 (2.1%)
Household income<$10,00027 (11.6%)16 (17.8%)11 (7.7%)
$10,000 - $19,99947 (20.2%)21 (23.3%)26 (18.2%)
$20,000 - $29,99929 (12.4%)13 (14.4%)16 (11.2%)
$30,000 - $39,99919 (8.2%)8 (8.9%)11 (7.7%)
$40,000 - $49,9998 (3.4%)4 (4.4%)4 (2.8%)
>$50,0006 (2.6%)5 (5.6%)1 (0,7%)
Declined to answer97 (41.6%)23 (25.6%)74 (51.7%)
  1. *

    p=0,000 Comparison of English- vs Spanish-speaking participants.

Table 1—source data 1

Telephone survey participant characteristics.

https://cdn.elifesciences.org/articles/84664/elife-84664-table1-data1-v2.zip
Table 2
Self-reported barriers among a subgroup of PRESTIS trial participants who were randomized to receive a mailed self-sample kit for HPV testing and completed a telephone survey from August 2020-September 2022 (n=233), Harris County, TX Source data file: ‘Table 2—source data 1’.
LanguageRace/Ethnicity
All (n=233) n (%)Spanish (n=143) n (%)English (n=90) n (%)p-valueHispanic (n=162) n (%)Black (n=51) n (%)White (n=14) n (%)Asian (n=3) n (%)Other (n=3) n (%)p-value
Getting a Pap is uncomfortable. Yes No Unsure158 (67.8%)
74 (31.8%)
1 (0.4%)		102 (71.3%)
41 (28.7%)
0 (0%)		56 (62.2%)
33 (36.7%)
1 (1.1%)		0.126112 (69.1%)
49 (30.3%)
1 (0.6%)		33 (64.7%)
18 (35.3%)
0 (0%)		8 (57.1%)
6 (42.9%)
0 (0%)		3 (100%)
0 (0%)
0 (0%)		2 (33.3%)
1 (66.7%)
0 (0%)		0.785
Uncomfortable with male provider Yes No Unsure147 (63.1%)
84 (36.1%)
2 (0.9%)		100 (69.9%)
41 (28.7%)
2 (1.4%)		47 (52.2%)
43 (47.8%)
0 (0%)		0.006109 (67.3%)
52 (32.1%)
1 (0.6%)		26 (51.0%)
25 (49.0%)
0 (0%)		6 (42.9%)
7 (50.0%)
1 (7.1%)		3 (100%)
0 (0%)
0 (0%)		3 (100%)
0 (0%)
0 (0%)		0.034
Getting a Pap is embarrassing Yes No Unsure122 (52.4%)
109 (46.8%)
2 (0.9%)		95 (66.4%)
48 (33.6%)
0 (0%)		27 (30%)
61 (67.8%)
2 (2.2%)		0.000100 (61.7%)
61 (37.7%)
1 (0.6%)		13 (25.5%)
37 (72.6%)
1 (2.0%)		6 (42.9%)
8 (57.1%)
0 (0%)		2 (66.7%)
0 (0%)
1 (33.3%)		1 (33.3%)
2 (66.7%)
0 (0%)		0.000
Getting a Pap test is expensive * Yes No Unsure47 (20.3%)
159 (68.5%)
26 (11.2%)		36 (25.6%)
94 (66.2%)
12 (8.5%)		11 (12.2%)
65 (72.2%)
14 (15.6%)		0.02439 (24.2%)
104 (64.6%)
18 (11.2%)		6 (11.8%)
38 (74.5%)
7 (13.7%)		0 (0%)
0 (0%)
14 (100%)		1 (66.7%)
2 (33.3%)
0 (0%)		1 (33.3%)
1 (33.3%)
1(33.3%)		0.049
AgeEducation†
30–39 (n=59)40–49 (n=78)50–59 (n=69)60–65 (n=27)p-valueElementary or less (n=64)Some/all High school (n=105)Some/all College (n=61)p-value
40 (67.8%)
18 (30.5%)
1 (1.7%)		57 (73.1%)
21 (26.9%)
0 (0%)		40 (58.0%)
29 (42.0%)
0 (0%)		21 (77.8%)
6 (22.2%)
0 (0%)		0.16041 (64.1%)
23 (35.9%)
0 (0.0%)		80 (76.2%)
24 (22.9%)
1 (1.0%)		35 (67.8%)
26 (42.6%)
0 (0%)		0.031
36 (61.0%)
22 (37.3%)
1 (1.7%)		46 (59.0%)
32 (41.0%)
0 (0%)		46 (66.7%)
23 (33.3%)
0 (0%)		19 (70.4%)
7 (25.9%)
1 (3.7%)		0.35745 (70.3%)
18 (28.1%)
1 (1.6%)		66 (62.9%)
38 (36.2%)
1 (1.0%)		34 (55.7%)
27 (44.3%)
0 (0%)		0.298
29 (49.2%)
30 (50.9%)
0 (0%)		43 (55.1%)
34 (43.6%)
1 (1.3%)		31 (44.9%)
37 (53.6%)
1 (1.5%)		19 (70.4%)
8 (29.6%)
0 (0%)		0.25236 (56.3%)
28 (43.8%)
0 (0%)		62 (59.1%)
42 (40.0%)
1 (1.0%)		22 (36.1%)
38 (62.3%)
1 (1.6%)		0.021
15 (25.4%)
38 (64.4%)6 (10.2%)		12 (15.4%)
58 (74.4%)
8 (10.3%)		14 (203%)
46 (66.7%)
9 (13.0%)		6 (23.1%)
17 (65.4%)
3 (11.5%)		0.84217 (27.0%)
44 (69.8%)
2 (3.2%)		24 (22.9%)
65 (61.9%)
16 (15.2%)		6 (9.8%)
47 (77.1%)
8 (13.1%)		0.12
  1. *

    Missing n=1.

  2. †

    Missing = 3.

Table 2—source data 1

Telephone survey results of barriers to getting provider-performed clinic-based screening among underscreened women participating in the PRESTIS study.

https://cdn.elifesciences.org/articles/84664/elife-84664-table2-data1-v2.zip
Table 3
Motivators- Self-sampling vs Pap among participants who self-reported completing the at-home self-sampling kit for HPV testing during a telephone survey (n=153), August 2020-September 2022, Harris County, TX Source data file: ‘Table 3—source data 1’.
LanguageRace/Ethnicity
All (N=153) n (%)Spanish N=93 n (%)English N=60 n (%)p-valueHispanic (n=108) n (%)Black (n=33) n (%)White (n=7) n (%)Asian (n=2) n (%)Other (n=3) n (%)p-value
Convenience of Pap vs self-sampling Self-sampling more convenient Pap more convenient Both are about the same85 (55.6%)
18 (11.8%)
50 (32.7%)		48 (51.6%)
14 (15.1%)
31 (33.3%)		37 (61.7%)
19 (31.7%)
4 (6.7%)		0.23758 (53.7%)
14 (13.0%)
36 (33.3%)		19 (57.6%)
3 (9.1%)
11 (33.3%)		6 (85.7%)
0 (0%)
1 (14.3%)		1 (50.0%)
0 (0%)
1 (50%)		1 (33.3%)
1 (33.3%)
1 (33.3%)		0.756
Embarrassment of Pap vs self-sampling Self-sampling more embarrassing Pap more embarrassing Both are about the same0 (0%)
106 (69.3%)
47 (30.7%)		0 (0%)
74 (79.6%)
19 (20.4%)		0 (0%)
32 (53.3%)
28 (46.7%)		0.0010 (0%)
79 (73.2%)
29 (26.9%)		0 (0%)
18 (54.6%)
15 (45.5%)		0 (0%)
4 (57.1%)
3 (42.9%)		0 (0%)
2 (100%)
0 (0%)		0 (0%)
3 (100%)
0 (0%)		0.158
Stress/anxiety of Pap vs self-sampling Self-sampling more stressful Pap more stressful Both are about the same6 (3.9%)
85 (55.6%)
62 (40.5%)		4 (4.3%)
52 (55.9%)
37 (39.8%)		2 (3.3%)
33 (55%)
25 (41.7%)		0.9406 (5.6%)
60 (55.6%)
42 (38.9%)		0 (0%)
18 (54.6%)
15 (45.5%)		0 (0%)
4 (57.1%)
3 (42.9%)		0 (0%)
0 (0%)
2 (100%)		0 (0%)
3 (100%)
0 (0%)		0.479
AgeEducation**
30–39 (n=39)40–49 (n=52)50–59 (n=42)60–65 (n=20)p-valueElementary or less (n=45)Some/all High school (n=66)Some/all College (n=40)p-value
Convenience of Pap vs self-sampling Self-sampling more convenient Pap more convenient Both are about the same23 (59.0%)
1 (2.6%)
15 (38.5%)		29 (55.8%)
9 (17.3%)
14 (26.9%)		20 (47.6%)
8 (19.1%)
14 (33.3%)		13 (65.0%)
0 (0%)
7 (35.0%)		0.09522 (48.9%)
7 (15.6%)
16 (35.6%)		37 (56.1%)
7 (10.6%)
22 (33.3%)		24 (60.05)
4 (10.0%)
12 (30.0%)		0.841
Embarrassment of Pap vs self-sampling Self-sampling more embarrassing Pap more embarrassing Both are about the same0 (0%)
25 (64.1%)
14 (35.9%)		0 (0%)
38 (73.1%)
14 (26.9%)		0 (0%)
26 (61.9%)
16 (38.1%)		0 (0%)
17 (85.0%)
3 (15.0%)		0.2420 (0%)
39 (86.7%)6 (13.3%)		0 (0%)
43 (65.2%)
23 (34.9%)		0 (0%)
22 (55.0%)
18 (45.0%)		0.005
Stress/anxiety of Pap vs self-sampling Self-sampling more stressful Pap more stressful Both are about the same2 (5.1%)
23 (59.0%)
14 (35.9%)		1 (1.9%)
29 (55.8%)
22 (42.3%)		3 (7.1%)
19 (45.2%)
20 (47.6%)		0 (0%)
14 (70.0%)
6 (30.0%)		0.5290 (0%)
27 (60.0%)
18 (40.0%)		5 (7.6%)
36 (54.6%)
25 (37.9%)		1 (2.5%)
21 (52.5%)
18 (45.0%)		0.318
Table 3—source data 1

Telephone survey results showing motivators of self-sampling vs. Pap.

https://cdn.elifesciences.org/articles/84664/elife-84664-table3-data1-v2.zip
Table 4
COVID-related barriers self-reported by PRESTIS trial participants who completed a telephone survey between August 2020 and September 2022, Harris County, TX Source data file: ‘Table 4—source data 1’.
COVID barriers for all patients (n=233)
LanguageRace/Ethnicity
All N=233 n (%)Spanish N=143 n (%)English N=90 n (%)p-valueHispanic (n=162) n (%)Black (n=51) n (%)White (n=14) n (%)Asian (n=3) n (%)Other (n=3) n (%)p-value
COVID-19 had economic effect Yes- large amount Yes- small amount No101 (43.4%) 82 (35.2%)
50 (21.5%)		60 (42%)
58 (40.6%) 25 (17.5%)		41 (45.6%) 24 (26.7%) 25 (17.5%)0.05268 (42.0%)
62 (38.35)
32 (19.8%)		24 (47.1%)
16 (31.4%)
11 (21.6%)		4 (28.6%)
4 (28.6%)
6 (42.9%)		3 (100%)
0 (0%)
0 (0%)		2 (66.6%)
0 (0%)
1 (33.3%)		0.280
COVID-19 affected mental health Yes- large amount Yes- small amount No34 (14.6%)
74 (31.8%) 125 (53.7%)		13 (9.1%)
41 (28.7%) 89 (62.2%)		21 (23.3%) 33 (36.7%) 36 (40%)0.00117 (10.5%) 50 (30.9%) 95 (58.6%)14 (27.5%)
19 (37.3%)
18 (35.3%)		2 (14.3%)
3 (21.4%)
9 (64.3%)		0 (0%)
1 (33.3%)
2 (66.7%)		1 (33.3%)
1 (33.3%)
1 (33.3%)		0.034
COVID-19 affected physical health Yes- large amount Yes- small amount No35 (15%)
57 (24.5%)
141 (60.5%)		20 (14%)
33 (23.1%) 90 (62.9%)		15 (16.7%) 24 (26.7%) 51 (56.7%)0.63320 (12.4%)
42 (25.9%)
100 (61.7%)		11 (25.6%)
12 (23.5%)
28 (54.9%)		3 (21.4%)
1 (7.1%)
10 (71.4%)		0 (0)%
1 (33.3%)
2 (66.7%)		1 (33.3%)
1 (33.3%)
1 (33.3%)		0.382
AgeEducation†
30–39 (n=59)40–49 (n=78)50–59 (n=69)60–65 (n=27)p-valueElementary or Less (n=64)Some/all High School (n=105)Some/all College (n=40)p-value
COVID-19 had economic effect Yes- large amount Yes- small amount No19 (32.2%)
30 (50.9%)
10 (17.0%)		36 (46.2%) 29 (37.2%) 13 (16.7%)36 (52.2%) 16 (23.2%) 17 (24.6%)10 (37.0%)
7 (25.9%)
10 (37.0%)		0.01521 (32.8%)
28 (43.8%) 15 (23.4%)		48 (45.7%)
34 (32.4%)
23 (21.9%)		30 (49.2%)
19 (31.2%)
12 (19.7%)		0.364
COVID-19 affected mental health Yes- large amount Yes- small amount No7 (11.9%)
21 (35.6%)
31 (52.5%)		11 (14.1%) 23 (29.5%) 44 (56.4%)11 (15.9%) 23 (33.3%) 35 (50.7%)5 (18.5%)
7 (25.9%)
15 (55.6%)		0.9473 (4.7%)
24 (37.5%) 37 (57.8%)		23 (21.9%)
24 (22.9%)
58 (55.2%)		7 (11.5%)
25 (41.0%)
29 (47.5%)		0.006
COVID-19 affected physical health Yes- large amount Yes- small amount No7 (11.9%)
12 (20.3%)
40 (67.8%)		13 (16.7%) 19 (24.4%) 46 (59.0%)12 (17.4%) 20 (29.0%) 37 (53.6%)3 (11.1%)
6 (22.2%)
18 (66.7%)		0.7624 (6.3%)
19 (29.7%) 41 (64.1%)		23 (21.9%)
19 (18.1%)
63 (60.0%)		7 (11.5%)
18 (29.5%)
36 (59.0%)		0.033
COVID barriers among those who completed self-sample kit (n=153)*
LanguageAge
All (N=153) n (%)Spanish N=93 n (%)English N=60 n (%)p-value30–39 (n=39) n (%)40–49 (n=52) n (%)50–59 (n=69) n (%)60–65 (n=27) n (%)p-value
COVID-19 affected participation in HPV self-sampling trial Yes No Don’t know91 (59.5%)
61 (39.9%)
1 (0.7%)		58 (62.4%) 34 (36.6%) 1 (1.1%)33 (55%) 27 (45%)
0 (0%)		0.53032 (82.1%)
7 (18.0%)
0 (0%)		27 (51.9%)
25 (48.1%)
0 (0%)		22 (52.4%)
19 (45.3%)
1 (2.4%)		10 (50%)
10 (50%)
0 (0%)		0.010
Categories of COVID barriers reported by those who reported that COVID affected their participation in the trial (n=92)*
All N=92 n (%)Spanish N=59 n (%)English N=33 n (%)p-value
Way that COVID affected participation Fear of getting COVID Difficulties getting appointment Easier at home Other38 (41.3%)
20 (21.7%)
11 (12%)
23 (25%)		24 (40.7%) 16 (27.1%)
7 (11.9%) 12 (20.3%)		14 (42.4%) 4 (12.1%)
4 (12.1%) 11 (33.3%)		0.304
  1. *

    No significant differences were found with race/ethnicity or education.

  2. †

    Missing n=3.

Table 4—source data 1

Telephone results showing COVID-related barriers self-reported by participants.

https://cdn.elifesciences.org/articles/84664/elife-84664-table4-data1-v2.zip

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  1. Susan Parker
  2. Ashish A Deshmukh
  3. Baojiang Chen
  4. David R Lairson
  5. Maria Daheri
  6. Sally W Vernon
  7. Jane R Montealegre
(2023)
Perceived barriers to cervical cancer screening and motivators for at-home human papillomavirus self-sampling during the COVID-19 pandemic: Results from a telephone survey
eLife 12:e84664.
https://doi.org/10.7554/eLife.84664