title: Perceptions of mailed HPV self-testing among women at higher risk for cervical cancer.
abstract: Whether human papillomavirus (HPV) self-testing can expand access to cervical cancer screening will depend on making the test accessible and acceptable to higher-risk women. To evaluate a novel delivery mode, we mailed HPV self-test kits to low-income, under-screened women and assessed their perceptions of self-testing and cervical cancer prevention. We conducted a telephone survey of 199 women in North Carolina. Eligibility criteria included not having had a Pap test in 4 years and reporting 1 or more indicators of economic hardship, such as being uninsured. Over half (55 %) of women in the diverse sample were non-Hispanic black, and almost three-quarters (74 %) reported annual household incomes of $20,000 or less. Trust in HPV self-testing was moderate to high, with almost all women (98 %) agreeing the mailed test was safe. A few women (6 %) preferred HPV self-testing to Pap testing for protecting health, but most (75 %) had no preference. Trust in or preference for mailed self-testing did not vary by race or income. However, compared to white women, black women had lower HPV-related knowledge (OR 0.46, 95 % CI 0.23-0.92) and perceived lower cervical cancer risk in the absence of screening (OR 0.44, 95 % CI 0.22-0.86). We found similar patterns of disparities for women with very low (<$10,000) versus relatively higher incomes. Our findings suggest that, across racial and economic subgroups, under-screened women generally trust HPV self-tests delivered by mail. To succeed, programs for HPV self-testing must overcome disparities in knowledge and perceptions related to cervical cancer screening.
authors.affiliation: School of Nursing, University of North Carolina, Chapel Hill, NC, USA, galbraik@email.unc.edu.
authors.forename: Kayoll V
authors.initials: KV
authors.lastname: Galbraith
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Gilkey
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
authors.forename: Alice R
authors.initials: AR
authors.lastname: Richman
authors.forename: Lynn
authors.initials: L
authors.lastname: Barclay
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003625:Data Collection; D005260:Female; D006801:Humans; D008875:Middle Aged; D009657:North Carolina; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000523:psychology; D011177:Postal Service; D012648:Self Care / Q000523:psychology*; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control / Q000523:psychology*