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
- Baylor College of Medicine, United States
- Medical University of South Carolina, United States
- UTHealth School of Public Health, United States
- Harris Health System, United States
Abstract
Background: Home-based self-sampling for human papillomavirus (HPV) testing may be an alternative for women not attending clinic-based cervical cancer screening.
Methods: We assessed barriers to care and motivators to use at-home HPV self-sampling kits during the COVID-19 pandemic as part of a randomized controlled trial evaluating kit effectiveness. Participants were women aged 30-65 and under-screened for cervical cancer in a safety-net healthcare system. We conducted telephone surveys in English/Spanish among a subgroup of trial participants, assessed differences between groups, and determined statistical significance at p<0.05.
Results: Over half of 233 survey participants reported that clinic-based screening (Pap) is uncomfortable (67.8%), embarrassing (52.4%), and discomfort seeing male providers (63.1%). The last two factors were significantly more prevalent among Spanish versus English speakers (66.4% vs. 30% (p=0.000) and 69.9 vs. 52.2% (p=0.006), respectively). Most women who completed the kit found Pap more embarrassing (69.3%), stressful (55.6%), and less convenient (55.6%) than the kit. The first factor was more prevalent among Spanish versus English speakers (79.6% vs. 53.38%, p=0.001) and among patients with elementary education or below.
Conclusions: The COVID-19 pandemic influenced most (59.5%) to participate in the trial due to fear of COVID, difficulty making appointments, and ease of using kits. HPV self-sampling kits may reduce barriers among under-screened women in a safety-net system.
Funding: This study is supported by a grant from the National Institute for Minority Health and Health Disparities (NIMHD, R01MD013715, PI: JR Montealegre).
Clinical trial number: NCT03898167.
Data availability
All data generated or analyzed during this study are included in the manuscript and supporting file; Source Data files have been provided for Tables 1-4.
Article and author information
Author details
Funding
National Institute for Minority Health and Health Disparities (R01MD013715)
- Jane R Montealegre
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: The survey was administered by trained, bilingual researcher coordinators in the patient's preferred language (English or Spanish). Participants were asked to provide verbal consent before commencing the survey and were sent a $20 gift card upon completion. This research was reviewed and approved by Baylor College of Medicine and Harris Health System's Institutional Review Boards (IRBs) (protocol ID H-44944). A waiver of written documentation of informed consent was granted by the IRBs for participants in the parent study given the minimal risks involved and to minimize participation bias. An IRB-approved verbal consent script was read to participants randomized to participate in the telephone survey. After being read the script, patients were given the opportunity to ask questions, and verbally indicated whether they consented to participate in the telephone survey. A consent to publish was not obtained as only aggregate data will be reported.
Copyright
© 2023, Parker et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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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
