title: Obtaining self-samples to diagnose curable sexually transmitted infections: a systematic review of patients' experiences.
abstract: BACKGROUND
  Routine screening is key to sexually transmitted infection (STI) prevention and control. Previous studies suggest that clinic-based screening programmes capture only a small proportion of people with STIs. Self-sampling using non- or minimally invasive techniques may be beneficial for those reluctant to actively engage with conventional sampling methods. We systematically reviewed studies of patients' experiences of obtaining self-samples to diagnose curable STIs.
  
  
  METHODS
  We conducted an electronic search of MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, and Cochrane Database of Systematic Reviews to identify relevant articles published in English between January 1980 and March 2014. Studies were included if participants self-sampled for the diagnosis of a curable STI and had specifically sought participants' opinions of their experience, acceptability, preferences, or willingness to self-sample.
  
  
  RESULTS
  The initial search yielded 558 references. Of these, 45 studies met the inclusion criteria. Thirty-six studies assessed patients' acceptability and experiences of self-sampling. Pooled results from these studies shows that self-sampling is a highly acceptable method with 85% of patients reporting the method to be well received and acceptable. Twenty-eight studies reported on ease of self-sampling; the majority of patients (88%) in these studies found self-sampling an "easy" procedure. Self-sampling was favoured compared to clinician sampling, and home sampling was preferred to clinic-based sampling. Females and older participants were more accepting of self-sampling. Only a small minority of participants (13%) reported pain during self-sampling. Participants were willing to undergo self-sampling and recommend others. Privacy and safety were the most common concerns.
  
  
  CONCLUSIONS
  Self-sampling for diagnostic testing is well accepted with the majority having a positive experience and willingness to use again. Standardization of self-sampling procedures and rigorous validation of outcome measurement will lead to better comparability across studies. Future studies need to conduct rigorous economic evaluations of self-sampling to inform policy development for the management of STI.
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom.
authors.forename: Priyamvada
authors.initials: P
authors.lastname: Paudyal
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom.
authors.forename: Carrie
authors.initials: C
authors.lastname: Llewellyn
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom.
authors.forename: Jason
authors.initials: J
authors.lastname: Lau
authors.affiliation: North-West Thames London Deanery, London, United Kingdom.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Mahmud
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Smith
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D012648:Self Care; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D013048:Specimen Handling