title: Attitudes and factors affecting acceptability of self-administered cervicovaginal sampling for human papillomavirus (HPV) genotyping as an alternative to Pap testing among multiethnic Malaysian women.
abstract: The objective of this study was to determine the attitudes and acceptability of self-administered cervicovaginal sampling compared with conventional physician-acquired Papanicolaou (Pap) smear among multiethnic Malaysian women.
  
  
  
  A cross-sectional study was carried out via interviewer-administered surveys from August 2013 through August 2015 at five government-run, urban health clinics in the state of Selangor. Subjects were participants from an ongoing community-based human papillomavirus (HPV) prevalence study who answered a standard questionnaire before and after self-sampling. The cervicovaginal self-sampling for HPV genotyping was performed using a simple brush ('Just for Me'; Preventive Oncology International, Hong Kong). Detailed data on sociodemographics, previous Pap smear experience, and attitudes towards self-administered cervicovaginal sampling were collected and analysed. Acceptability was inferred using a five-item Likert scale that included six different subjective descriptives: experience, difficulty, convenience, embarrassment, discomfort or pain, and confidence in collecting one's own sample.
  
  
  
  Of the 839 participants, 47.9% were Malays, followed by 30.8% Indians, 18.8% Chinese and 2.5% from other ethnicities. The median age of the participants was 38 years (IQR 30-48). Some 68.2% of participants indicated a preference for self-sampling over the Pap test, with 95% indicating willingness to follow-up a positive result at the hospital. Age, ethnicity and previous Pap test experience were significant independent factors associated with preference for self-sampling. The older the individual, the less likely they were to prefer self-sampling (adjusted OR 0.94, 95% CI 0.90 to 0.98). The Chinese were less likely to prefer self-sampling (72.6%) than the Malays (85.1%) (adjusted OR 0.57, 95% CI 0.33 to 0.98, p=0.004). Participants who had never undergone a Pap smear were also more likely to prefer self-sampling (88.5%) than women who had undergone a previous Pap (80.9%) (adjusted OR 0.06, 95% CI 0.35 to 0.87).
  
  
  
  Overall, urban Malaysian women from multiethnic backgrounds found self-sampling to be an acceptable alternative to Pap smear.
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Mahirah
authors: M
authors: Ma'som
authors: National Clinical Research Centre, Ministry of Health, Malaysia Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors: Nirmala
authors: N
authors: Bhoo-Pathy
authors: Selangor State Health Department, Klinik Kesihatan Pandamaran, Ministry of Health, Kuala Lumpur, Malaysia.
authors: Nazrila Hairizan
authors: NH
authors: Nasir
authors: Preventive Oncology International Inc, Cleveland Heights, Ohio and The Women's Health Institute of the Cleveland Clinic, Cleveland, Ohio, USA.
authors: Jerome
authors: J
authors: Bellinson
authors: National Clinical Research Centre, Ministry of Health, Malaysia.
authors: Shridevi
authors: S
authors: Subramaniam
authors: Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
authors: Yuntong
authors: Y
authors: Ma
authors: University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia.
authors: Siew-Hwei
authors: SH
authors: Yap
authors: National Clinical Research Centre, Ministry of Health, Malaysia.
authors: Pik-Pin
authors: PP
authors: Goh
authors: Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA.
authors: Patti
authors: P
authors: Gravitt
authors: Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia.
authors: Yin Ling
authors: YL
authors: Woo
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods; D005006:Ethnicity; D005260:Female; D060005:Genotyping Techniques; D006801:Humans; D016015:Logistic Models; D008296:Malaysia; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test / Q000379:methods; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000517:prevention & control; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013048:Specimen Handling / Q000379:methods*; D011795:Surveys and Questionnaires; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014626:Vaginal Smears / Q000379:methods
keywords: cervical cancer screening; cervico-vaginal sampling; human papillomavirus; pap smear; self sampling