title: Human papillomavirus self-sampling for screening nonattenders: Opt-in pilot implementation with electronic communication platforms.
abstract: In organized cervical screening programs, typically 25% of the invited women do not attend. The Copenhagen Self-sampling Initiative (CSi) aimed to gain experiences on participation among screening nonattenders in the Capital Region of Denmark. Here, we report on the effectiveness of different communication platforms used in the pilot with suggestions for strategies prior to a full-implementation. Moreover, an innovative approach using self-sampling brushes with unique radio frequency identification chips allowed for unprecedented levels patient identification safety. Nonattenders from the capital region of Denmark were identified via the organized national invitation module. Screening history was obtained via the nationwide pathology registry. Twenty-four thousand women were invited, and as an alternative to the regular communication platforms (letter and phone), women could request a home test via a mobile-friendly webpage. Instruction material and video-animation in several languages were made available online. Chi-square test was used to test differences. Out of all invited, 31.7% requested a home test, and 20% returned it to the laboratory. In addition, 10% were screened at the physician after receiving the invitation. Stratified by screening history, long-term unscreened women were less likely to participate than intermittently screened women (28% vs. 16%, p < 0.001). Of all contacts received, 64% (63-65) came via letter, and 31% (95CI: 30-32%) via webpage/mobile-app. Self-sampling was well-accepted among nonattenders. Adopting modern technology-based platforms into the current organized screening program would serve as a convenient communication method between health authority and citizens, allowing easy access for the citizen and reducing the work load in administrating self-sampling approaches.
authors.affiliation: Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Janni Uyen Hoa
authors.identifier: 0000-0003-4304-4399
authors.initials: JU
authors.lastname: Lam
authors.affiliation: Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Matejka
authors.initials: M
authors.lastname: Rebolj
authors.affiliation: Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Ditte
authors.initials: D
authors.lastname: Møller Ejegod
authors.affiliation: Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Pedersen
authors.affiliation: Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Carsten
authors.initials: C
authors.lastname: Rygaard
authors.affiliation: Department of Public Health, University of Copenhagen, Denmark.
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Lynge
authors.affiliation: Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Thirstrup Thomsen
authors.affiliation: Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.|Department of Obstetrics and Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: Krüger Kjaer
authors.affiliation: Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.|Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Bonde
mesh_terms: D000328:Adult; D000368:Aged; D003718:Denmark; D059026:Diagnostic Self Evaluation; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011379:Prognosis; D012648:Self Care / Q000379:methods*; D013048:Specimen Handling; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult
keywords: HPV-based self-sampling; cervical cancer screening; electronic communication platforms; pilot implementation study; screening nonattenders