Self-administered HPV testing as a cervical cancer screening option: Exploring the perspectives of hispanic and Arab women in the United States .

Kidder, E.O. (2014). Self-administered HPV testing as a cervical cancer screening option: Exploring the perspectives of hispanic and Arab women in the United States (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 3630899)

Background: Though significant gains have been made in preventing cervical cancer over the past 30 years, it continues to cause morbidity and mortality among women in the United States, particularly among those women who are screened infrequently or not at all. More than half of cervical cancer deaths in the U.S. are among immigrants, and the incidence and mortality from cervical cancer is increasing among foreign-born women. Arab and Hispanic women living in the U.S. continue to have cervical cancer screening rates that are lower than the general population. Understanding what factors influence their cervical cancer screening practices and what new screening options may overcome their barriers to preventive screening may be effective in reducing disparities in the disease burden of cervical cancer. 

HPV DNA testing has taken on a larger role in cervical cancer screening, and there is increasing evidence and support for the use of HPV testing alone as a primary cervical cancer screening test. Novel health screening devices have been developed that allow women to self-screen for HPV, which may offer opportunity to simplify the cervical cancer screening protocol and reach women who are not receiving recommended cervical cancer screening services. 

Objective: Because self-administered screening devices are not yet available and most women have not had exposure to them, there are limited quantitative and qualitative assessments of women’s attitudes towards and likelihood to use such devices, particularly in the U.S. This study informs the development of culturally appropriate interventions and policies intended to improve cervical cancer screening rates among Arab and Hispanic women in the United States, and discusses implementation challenges and policy implications associated with incorporating self-administered HPV testing into the cervical cancer screening protocol in the U.S. 

Methods: A paper-based survey (n = 476) and individual interviews (n = 31) were used to explore Arab and Hispanic participants’ screening behaviors, likelihood to use HPV self-administered tests to screen for cervical cancer, perceived self-efficacy in using self-screening tests, and major concerns they have about self-screening. 

Results: Participants who were 1) uninsured, 2) knowledgeable about HPV and cervical cancer, 3) had high self-efficacy in their ability to use a self-screening test; and 4) had no concerns about the self-screening test were significantly more likely to use a self-screening test. Hispanic participants (74.0%) were significantly more likely than Arab participants (43.8%) to report they would be likely to use a self-administered cervical cancer screening test if it were available. Approximately half of uninsured (52.7%) and underscreened (47.1%) participants reported they would be more likely to get screened for cervical cancer if an at-home self-screening test were available. 

Conclusions: A majority of participants responded positively to the option for HPV self-testing as a cervical cancer screening option, suggesting that it may an effective screening modality to reach women who are not accessing routine screening. More research is needed on implementing a self-screening option, particularly among underscreened populations. 

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