title: Attitudes towards cytology and human papillomavirus self-sample collection for cervical screening among Hindu women in London, UK: a mixed methods study.
abstract: OBJECTIVE
  To explore the attitudes, views and understanding of women attending a Hindu temple in London, UK towards cervical screening, human papillomavirus (HPV) testing and two HPV self-sample collection devices: the Dacron swab and Evalyn(®) brush.
  
  
  METHODS
  A mixed methods design comprising a survey and four focus groups was adopted. Focus group discussions were recorded and transcribed verbatim and explored using thematic framework analysis.
  
  
  RESULTS
  A total of 185 Hindu women completed surveys and 23 attended focus groups. Of the respondents 75% aged 25-64 years reported having cervical screening within the last 5 years; 85% had attended college or university. Familiar barriers to attendance for screening were identified: fear of pain and the test result, embarrassment, screener's attitude, inconvenient appointment times and difficulty with child care. Additional barriers cited included age and country of birth, with older and Indian-born women thought to be less likely to attend for screening. Self-collected sampling had a mixed reception. Women were not confident that their sample would be as good as a clinician sample and expressed concern about the impact that a positive HPV result might have on their relationships.
  
  
  CONCLUSIONS
  Screening attendance in this highly educated group of Hindu women was slightly lower than in the general population (75% of women aged 25-64 years had been screened in the last 5 years compared with 79% in England as a whole). Familiar barriers to screening were identified. Women felt able to collect their own sample for HPV testing with a Dacron swab but lacked confidence that it would be as good as that obtained by a clinician.
authors: Research Nurse Consultant, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK.
authors: Louise
authors: L
authors: Cadman
authors: Research Nurse, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK.
authors: Lesley
authors: L
authors: Ashdown-Barr
authors: Senior Research Associate, Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
authors: Jo
authors: J
authors: Waller
authors: Clinical Senior Lecturer, Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK Deceased.
authors: Anne
authors: A
authors: Szarewski
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D018596:Hinduism / Q000523:psychology*; D006801:Humans; D008131:London; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000517:prevention & control; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012648:Self Care / Q000523:psychology*; D013048:Specimen Handling / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: Cervical Screening; Ethnic Minority and Cultural Issues; Human Papillomavirus