title: Factors influencing Malawian women's willingness to self-collect samples for human papillomavirus testing.
abstract: BACKGROUND
  Malawi has the highest incidence of cervical cancer in the world. Only 3% of Malawian women have ever been screened for cervical cancer. Self-collection of samples for human papillomavirus (HPV) testing could increase screening among under-screened and hard-to-reach populations. However, little is known about the acceptability of self-collection in rural African settings.
  
  
  OBJECTIVE
  We aimed to characterise Malawian women's willingness to self-collect vaginal samples for HPV testing and to identify potential barriers.
  
  
  METHODS
  We used data from the baseline wave of a community-based cohort study, collected from July 2014 to February 2015.
  
  
  METHODS
  Participants were enrolled from the catchment area of a clinic in rural Lilongwe District, Malawi.
  
  
  METHODS
  We enrolled women aged 15-39 years (n=824). Participants answered questions assessing willingness to self-collect a sample for HPV testing, concerns about testing and other hypothesised correlates of willingness to self-collect.
  
  
  RESULTS
  Two-thirds (67%) of the women reported willingness to self-collect a vaginal sample in their homes. Awareness of cervical cancer, supportive subjective norms, perceived behavioural control, and clinician recommendations were all positively associated with increased willingness to self-collect samples for HPV testing. Identified barriers to self-testing endorsed by women included: concerns that the test might hurt (22%), that they might not do the test correctly (21%), and that the test might not be accurate (17%).
  
  
  CONCLUSIONS
  This study suggests that self-collection for HPV testing could be an acceptable cervical cancer screening method in this rural population. Findings identify modifiable beliefs and barriers that can inform the development of effective screening programmes.
authors.affiliation: Doctoral Candidate, Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Allahna
authors.initials: A
authors.lastname: Esber
authors.affiliation: Assistant Professor, Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Annie-Laurie
authors.initials: AL
authors.lastname: McRee
authors.affiliation: Associate Professor, Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Norris Turner
authors.affiliation: Assistant Professor, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Lilongwe, Malawi.
authors.forename: John
authors.initials: J
authors.lastname: Phuka
authors.affiliation: Assistant Professor, Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Norris
keywords: Malawi; cervical screening; epidemiology; human papillomavirus