title: Community-Based Screening for Cervical Cancer: A Feasibility Study of Rural Appalachian Women.
abstract: OBJECTIVE
  To describe women's comfort levels and perceptions about their experience self-collecting cervicovaginal swabs for human papillomavirus (HPV) testing, to determine whether nurse-guided patient navigation increases the odds of women receiving a traditional Papanicolaou (Pap) test after HPV screening, and to test the hypothesis that women testing positive for oncogenic HPV would be more likely to have a subsequent Pap test than those testing negative.
  
  
  METHODS
  A total of 400 women were recruited from 8 rural Appalachian counties, in 2013 and 2014. After completing a survey, women were provided instructions for self-collecting a cervicovaginal swab. Specimens were tested for 13 oncogenic HPV types. Simultaneously, women were notified of their test results and offered initial navigation for Pap testing. Chart-verified Pap testing within the next 6 months served as the end point.
  
  
  RESULTS
  Comfort levels with self-collection were high: 89.2% indicated that they would be more likely to self-collect a specimen for testing, on a regular basis, compared with Pap testing. Thirty women (7.5%) had a follow-up Pap test. Women receiving added nurse-guided navigation efforts were significantly less likely to have a subsequent test (P = 0.01). Women testing positive for oncogenic HPV were no more likely than those testing negative to have a subsequent Pap test (P = 0.27). Data were analyzed in 2014.
  
  
  CONCLUSIONS
  Rural Appalachian women are comfortable self-collecting cervicovaginal swabs for HPV testing. Furthermore, efforts to recontact women who have received an oncogenic HPV test result and an initial navigation contact may not be useful. Finally, testing positive for oncogenic HPV may not be a motivational factor for subsequent Pap testing.
authors.affiliation: From the *College of Public Health, University of Kentucky, Lexington, KY; and †Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Crosby
authors.forename: Michael E
authors.initials: ME
authors.lastname: Hagensee
authors.forename: Robin
authors.initials: R
authors.lastname: Vanderpool
authors.forename: Nia
authors.initials: N
authors.lastname: Nelson
authors.forename: Adam
authors.initials: A
authors.lastname: Parrish
authors.forename: Tom
authors.initials: T
authors.lastname: Collins
authors.forename: Nebraska
authors.initials: N
authors.lastname: Jones
mesh_terms: D000328:Adult; D001061:Appalachian Region / Q000453:epidemiology; D004279:DNA, Viral; D055088:Early Detection of Cancer / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods; D008507:Medically Underserved Area; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data*; D013048:Specimen Handling / Q000523:psychology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data; D016387:Women's Health
chemical_list: D004279:DNA, Viral