title: Self-collecting a cervico-vaginal specimen for cervical cancer screening: an exploratory study of acceptability among medically underserved women in rural Appalachia.
abstract: OBJECTIVE
  Innovative screening methods such as self-testing for human papillomavirus (HPV) may alleviate barriers to cervical cancer screening. The purpose of this exploratory study was to determine whether Appalachian Kentucky women would be amenable to self-collecting a cervico-vaginal specimen for HPV testing.
  
  
  METHODS
  Women aged 30-64 who were overdue for guideline-recommended cervical cancer screening were recruited from a primary care clinic in southeastern Kentucky. The women were asked to self-collect a specimen, using a cervico-vaginal brush, based on verbal and printed directions provided by a research nurse. All study participants, regardless of laboratory-confirmed HPV status, received the same counseling on the importance of cervical cancer screening and offered navigation to follow-up Pap testing at the local health department.
  
  
  RESULTS
  Thirty-one women were approached and recruited to participate in the study, indicating a 100% acceptance rate of HPV self-testing. Of the 31 women, 26 tested negative for high-risk HPV and five tested positive. All of the women with negative results declined nurse navigation to Pap testing, whereas four of the five women with positive results accepted nurse navigation and received subsequent Pap smear screenings (all results were normal).
  
  
  CONCLUSIONS
  Among this sample of Appalachian Kentucky women, self-collecting a cervico-vaginal specimen for HPV testing was highly acceptable. This exploratory study provides impetus for larger studies among high-risk, medically underserved women in rural communities. Tailoring alternative cancer screening strategies to meet the complex needs of rural women is likely to lead to reductions in cervical cancer incidence and mortality among this vulnerable population.
authors.affiliation: Department of Health Behavior, University of Kentucky College of Public Health, Lexington, KY, USA. Electronic address: robin@kcr.uky.edu.
authors.forename: Robin C
authors.initials: RC
authors.lastname: Vanderpool
authors.affiliation: University of Kentucky Rural Cancer Prevention Center, Hazard, KY, USA.
authors.forename: Maudella G
authors.initials: MG
authors.lastname: Jones
authors.affiliation: Department of Health Behavior, University of Kentucky College of Public Health, Lexington, KY, USA.
authors.forename: Lindsay R
authors.initials: LR
authors.lastname: Stradtman
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Health Behavior, University of Kentucky College of Public Health, Lexington, KY, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Crosby
mesh_terms: D000328:Adult; D001061:Appalachian Region; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007629:Kentucky; D008507:Medically Underserved Area; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population; D016353:Self-Examination; D013048:Specimen Handling / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D014626:Vaginal Smears / Q000379:methods*
keywords: Acceptance; Appalachia; Cervical cancer; HPV testing; Patient navigation