title: Self-sampling experiences among non-attendees to cervical screening.
abstract: OBJECTIVE
  High coverage and attendance is essential to positive cervical cancer screening results. Offering self-sampling for HPV-testing to the non-attendees of the program may improve attendance rates. Information on women's perceptions and experiences with self-sampling (acceptability) is needed to further optimize attendance by this method.
  
  
  METHODS
  A questionnaire study focusing on women's experiences on the screening method was embedded in a trial investigating the effects and feasibility of self-sampling among non-attendees of cervical screening in 31 Finnish municipalities in 2011-2012 (n=4688). Reasons for non-attendance in routine screening were also surveyed.
  
  
  RESULTS
  Response rate to the questionnaire was 98.8% (909/920) among women who performed self-sampling. Self-sampling participants reported mainly good experiences. Negative experiences (difficulties in sample taking, pain, fear, anxiety, insecurity) were reported rarely, but more commonly among women with a mother tongue other than Finnish or Swedish (immigrants). Most common reason for non-attendance in routine screening was a recent Pap-smear elsewhere (opportunistic screening). Practical reasons (pregnancy, scheduling difficulties) were reported by 42%, emotional or attitudinal reasons by 17%, and 16% forgot to take part. Response yield to questionnaire was unsatisfactory among those women who declined the self-sampling option.
  
  
  CONCLUSIONS
  Optimizing the practical aspects of screening and offering a self-sampling option to non-attendees can help to overcome a large variety of both practical and emotional barriers to traditional screening. More research is needed among the non-attendees to routine screening who decline also the self-sampling option.
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland. Electronic address: anni.virtanen@cancer.fi.
authors.forename: Anni
authors.initials: A
authors.lastname: Virtanen
authors.affiliation: Helsinki University Central Hospital, Department of Obstetrics and Gynecology, Jorvi Hospital, PL 800, 00029 HUS, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Nieminen
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland.
authors.forename: Meri
authors.initials: M
authors.lastname: Niironen
authors.affiliation: Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland.
authors.forename: Tapio
authors.initials: T
authors.lastname: Luostarinen
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland.
authors.forename: Ahti
authors.initials: A
authors.lastname: Anttila
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012648:Self Care / Q000379:methods / Q000523:psychology*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods* / Q000523:psychology*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
keywords: Acceptability; Cervical screening; HPV; Non-attendance; Self-sampling