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 L 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

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

  1. Susan L Parker

    Baylor College of Medicine, Houston, United States
    For correspondence
    susan.parker2@bcm.edu
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-6722-4717
  2. Ashish A Deshmukh

    Medical University of South Carolina, Charleston, United States
    Competing interests
    The authors declare that no competing interests exist.
  3. Baojiang Chen

    Michael and Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin, United States
    Competing interests
    The authors declare that no competing interests exist.
  4. David R Lairson

    Michael and Susan Dell Center for Healthy Living, UTHealth School of Public Health, Houston, United States
    Competing interests
    The authors declare that no competing interests exist.
  5. Maria Daheri

    Harris Health System, Houston, United States
    Competing interests
    The authors declare that no competing interests exist.
  6. Sally W Vernon

    Michael and Susan Dell Center for Healthy Living, UTHealth School of Public Health, Houston, United States
    Competing interests
    The authors declare that no competing interests exist.
  7. Jane R Montealegre

    Baylor College of Medicine, Houston, United States
    Competing interests
    The authors declare that no competing interests exist.

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.

Reviewing Editor

  1. Johannes Berkhof, Amsterdam UMC Location VUmc, Netherlands

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.

Version history

  1. Received: November 3, 2022
  2. Preprint posted: November 22, 2022 (view preprint)
  3. Accepted: May 25, 2023
  4. Accepted Manuscript published: May 26, 2023 (version 1)
  5. Version of Record published: July 11, 2023 (version 2)

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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  1. Susan L 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

Share this article

https://doi.org/10.7554/eLife.84664

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