Barriers and Facilitators to Cervical Cancer Screening Among Women in Rural Ontario, Canada: The Role of Self‐Collected HPV Testing

• Published in: The Journal of rural health Vol. 32; no. 2; pp. 136 - 145
• Main Authors: Racey, C. Sarai, Gesink, Dionne C.
• Format: Journal Article
• Language: English
• Published: England Journal of Rural Health 01-03-2016; Blackwell Publishing Ltd; Wiley Subscription Services, Inc
• Subjects: Ability; Adolescent; Adult; Age differences; Age Factors; Aged; Barriers; Cancer; Cervical cancer; Cervix; Communities; Constraints; Early Detection of Cancer - methods; Embarrassment; Facilitators; Fear; Fear & phobias; Female; Females; Focus Groups; Generational differences; Group research; Health Knowledge, Attitudes, Practice; health services research; HPV testing; Human papillomavirus; Humans; Implementation; Invasive; Invasiveness; Mass Screening - methods; Mass Screening - psychology; Medical screening; Middle Aged; Older women; Ontario; Papillomavirus Infections - diagnosis; Patient Acceptance of Health Care - psychology; Qualitative analysis; Qualitative research; Reliability; Reproducibility of Results; Rural areas; Rural communities; Rural Population; Sampling; Screening; Self; Self Efficacy; Social distance; Time Factors; Trust; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - virology; utilization of health services; Vaginal Smears; Young Adult; Young women; Ontario; Ontario Canada; Canada; Canada, Ontario; utilization of health services; HPV testing; health services research; qualitative research; cervical cancer
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12136

PURPOSE: The addition of human papillomavirus (HPV) testing to primary cervical cancer screening provides an opportunity to employ less invasive cervical cancer screening modalities. The objective of this study was to explore the initial reaction and perception to HPV self‐collected testing, in the context of current barriers and facilitators to cervical cancer screening, among women in an underscreened community in rural Ontario. METHODS: Age‐stratified focus groups were conducted with women 18‐70 years of age in rural Ontario to discuss cervical cancer screening. Women were recruited using purposive sampling of underscreened women and women in the general community. Qualitative thematic analysis of focus group transcripts identified the barriers, facilitators, and role of HPV self‐collected testing for cervical cancer screening. RESULTS: Four focus groups were conducted with a total of 25 women. Overall, women were very positive toward self‐collected HPV testing. HPV self‐collected testing was felt to address many of the logistical (eg, inconvenient clinic hours, lack of time) and procedural barriers (embarrassment, lack of social distance in a small town) to current screening practices. However, self‐collected HPV testing does not address barriers related to cervical cancer knowledge (eg, fear of cancer). Women identified issues related to test reliability, confidence in the ability to self‐collect, and education around testing that would need to be addressed prior to implementation. Generational differences were noted in the acceptability of self‐collected HPV testing between older and younger women. CONCLUSIONS: HPV self‐collected testing was perceived as a facilitator for screening, and it was well accepted in this rural community.