title: Women's experience with home-based self-sampling for human papillomavirus testing.
abstract: BACKGROUND
  Increasing cervical screening coverage by reaching inadequately screened groups is essential for improving the effectiveness of cervical screening programs. Offering HPV self-sampling to women who are never or under-screened can improve screening participation, however participation varies widely between settings. Information on women's experience with self-sampling and preferences for future self-sampling screening is essential for programs to optimize participation.
  
  
  METHODS
  The survey was conducted as part of a larger trial ("iPap") investigating the effect of HPV self-sampling on participation of never and under-screened women in Victoria, Australia. Questionnaires were mailed to a) most women who participated in the self-sampling to document their experience with and preference for self-sampling in future, and b) a sample of the women who did not participate asking reasons for non-participation and suggestions for enabling participation. Reasons for not having a previous Pap test were also explored.
  
  
  RESULTS
  About half the women who collected a self sample for the iPap trial returned the subsequent questionnaire (746/1521). Common reasons for not having cervical screening were that having Pap test performed by a doctor was embarrassing (18 %), not having the time (14 %), or that a Pap test was painful and uncomfortable (11 %). Most (94 %) found the home-based self-sampling less embarrassing, less uncomfortable (90 %) and more convenient (98%) compared with their last Pap test experience (if they had one); however, many were unsure about the test accuracy (57 %). Women who self-sampled thought the instructions were clear (98 %), it was easy to use the swab (95 %), and were generally confident that they did the test correctly (81 %). Most preferred to take the self-sample at home in the future (88 %) because it was simple and did not require a doctor's appointment. Few women (126/1946, 7 %) who did not return a self-sample in the iPap trial returned the questionnaire. Their main reason for not screening was having had a hysterectomy.
  
  
  CONCLUSIONS
  Home-based self-sampling can overcome emotional and practical barriers to Pap test and increase participation in cervical screening despite some women's concerns about test accuracy. Mailing to eligible women and assuring women about test accuracy could further optimize participation in screening.
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. sultanaf@student.unimelb.edu.au.
authors.forename: Farhana
authors.initials: F
authors.lastname: Sultana
authors.affiliation: Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Vic, 3004, Australia. rmmcmm@bigpond.com.
authors.forename: Robyn
authors.initials: R
authors.lastname: Mullins
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. d.english@unimelb.edu.au.|Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Vic, 3004, Australia. d.english@unimelb.edu.au.
authors.forename: Dallas R
authors.initials: DR
authors.lastname: English
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. julieas@unimelb.edu.au.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Simpson
authors.affiliation: Victorian Cervical Cytology Registry, PO Box 161, Carlton South, Vic, 3053, Australia. kdrennan@vcs.org.au.
authors.forename: Kelly T
authors.initials: KT
authors.lastname: Drennan
authors.affiliation: VCS Pathology, 265 Faraday Street, Carlton, Vic, 3053, Australia. sheley@vcs.org.au.
authors.forename: Stella
authors.initials: S
authors.lastname: Heley
authors.affiliation: Royal Women's Hospital, Locked Bag 300, Cnr Flemington Road and Grattan Street, Parkville, VIC, 3052, Australia. david.wrede@thewomens.org.au.|Department of Obstetrics & Gyneacology, University of Melbourne, Melbourne, Australia. david.wrede@thewomens.org.au.
authors.forename: C David
authors.initials: CD
authors.lastname: Wrede
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. jbrother@vcs.org.au.|VCS Inc, 265 Faraday Street, Carlton, Vic, 3053, Australia. jbrother@vcs.org.au.|National HPV Vaccination Program Register, Victorian Cytology Service, PO Box 310, East Melbourne, Vic, 3002, Australia. jbrother@vcs.org.au.
authors.forename: Julia M L
authors.initials: JM
authors.lastname: Brotherton
authors.affiliation: VCS Inc, 265 Faraday Street, Carlton, Vic, 3053, Australia. msaville@vcs.org.au.|VCS Pathology, 265 Faraday Street, Carlton, Vic, 3053, Australia. msaville@vcs.org.au.
authors.forename: Marion
authors.initials: M
authors.lastname: Saville
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. dgertig@vcs.org.au.|Victorian Cervical Cytology Registry, PO Box 161, Carlton South, Vic, 3053, Australia. dgertig@vcs.org.au.|VCS Inc, 265 Faraday Street, Carlton, Vic, 3053, Australia. dgertig@vcs.org.au.
authors.forename: Dorota M
authors.initials: DM
authors.lastname: Gertig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012189:Retrospective Studies; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires; D055815:Young Adult