Barriers and Facilitators to Cervical Cancer Screening Among Women in Rural Ontario, Canada: The Role of Self-Collected HPV Testing.
OBJECTIVE
The addition of human papillomavirus (HPV) testing to primary cervical cancer screening provides an opportunity to employ less invasive cervical cancer screening modalities. The objective of this study was to explore the initial reaction and perception to HPV self-collected testing, in the context of current barriers and facilitators to cervical cancer screening, among women in an underscreened community in rural Ontario.


METHODS
Age-stratified focus groups were conducted with women 18-70 years of age in rural Ontario to discuss cervical cancer screening. Women were recruited using purposive sampling of underscreened women and women in the general community. Qualitative thematic analysis of focus group transcripts identified the barriers, facilitators, and role of HPV self-collected testing for cervical cancer screening.


RESULTS
Four focus groups were conducted with a total of 25 women. Overall, women were very positive toward self-collected HPV testing. HPV self-collected testing was felt to address many of the logistical (eg, inconvenient clinic hours, lack of time) and procedural barriers (embarrassment, lack of social distance in a small town) to current screening practices. However, self-collected HPV testing does not address barriers related to cervical cancer knowledge (eg, fear of cancer). Women identified issues related to test reliability, confidence in the ability to self-collect, and education around testing that would need to be addressed prior to implementation. Generational differences were noted in the acceptability of self-collected HPV testing between older and younger women.


CONCLUSIONS
HPV self-collected testing was perceived as a facilitator for screening, and it was well accepted in this rural community.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
C Sarai
CS
Racey
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Dionne C
DC
Gesink
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods; D005239:Fear; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D009864:Ontario; D030361:Papillomavirus Infections / Q000175:diagnosis*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D015203:Reproducibility of Results; D012424:Rural Population; D020377:Self Efficacy; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult
HPV testing; cervical cancer; health services research; qualitative research; utilization of health services