title: Women's perspectives on human papillomavirus self-sampling in the context of the UK cervical screening programme.
abstract: Testing for human papillomavirus (HPV) is being incorporated into the cervical screening programme, with the probable future introduction of HPV as a primary test and a possibility of HPV self-sampling. In anticipation of this development, we sought to inform future policy and practice by identifying potential barriers to HPV self-sampling.
  
  
  
  A cross-sectional survey of 194 women aged 20-64 years was conducted. Logistic regression analysis was used to identify determinants of self-sampling intentions. A purposive subsample of 19 women who reported low self-sampling intentions were interviewed. Interviews were framework-analysed.
  
  
  
  Most survey participants (N=133, 69.3%) intended to HPV self-sample. Lower intention was associated with lower self-efficacy (OR=24.96, P≤.001), lower education (OR=6.06, P≤.05) and lower perceived importance of HPV as a cause of cervical cancer (OR=2.33, P≤.05). Interviews revealed personal and system-related barriers. Personal barriers included a lack of knowledge about HPV self-sampling, women's low confidence in their ability to self-sample correctly and low confidence in the subsequent results. System-related factors included a lack of confidence in the rationale for modifying the current cervical screening programme, and concerns about sample contamination and identity theft.
  
  
  
  Insights gained from this research can be used to guide further enquiry into the possibility of HPV self-sampling and to help inform future policy and practice. Personal and system-related barriers including low confidence in the reasons for changing current cervical screening provision need to be addressed, should HPV self-sampling be incorporated into the cervical screening programme.
authors.affiliation: Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Denitza
authors.identifier: 0000-0002-2874-9270
authors.initials: D
authors.lastname: Williams
authors.affiliation: School of Social Sciences, Bangor University, Bangor, UK.
authors.forename: Myfanwy
authors.initials: M
authors.lastname: Davies
authors.affiliation: Leading Safe Choices programme, Royal College of Obstetricians and Gynaecologists, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Fiander
authors.affiliation: Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Farewell
authors.affiliation: Screening Division, Public Health Wales, Cardiff, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Hillier
authors.affiliation: Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Brain
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D006113:United Kingdom; D055815:Young Adult
keywords: 
  HPV
  ; attitudes; cervical screening; human papillomavirus; intentions; self-sampling