Acceptability of non-speculum clinician sampling for cervical screening in older women: A qualitative study

Abstract

Objectives: One reason that women over age 50 report avoiding cervical screening is increased discomfort postmenopause. This study aimed to explore the acceptability of human papillomavirus testing on clinician-collected vaginal samples without a speculum (ʼnon-speculum’) for cervical screening among older women. Methods: Thirty-eight women in England aged 50-64 with a range of cervical screening experience (‘up-to-date’ n=17, ‘overdue screening’ n=18, ʼnever screened’ n=3) were identified via a recruitment agency. Women participated in focus groups or interviews about the potential for using clinician-collected samples without a speculum. Discussions were analysed using Framework Analysis. Results: The two main themes identified were women’s perceptions of the speculum and attitudes towards non-speculum screening. Many women reported negative experiences with the speculum, including increased pain after the menopause. Women generally had positive attitudes towards non-speculum clinician sampling and felt it would be a less intrusive option, but expressed concern that it could be less accurate than screening with a speculum. Women who were ‘up-to-date’ preferred conventional screening, while overdue and never screened women welcomed the option to be screened without a speculum. Conclusions: Human papillomavirus testing on non-speculum clinician-collected vaginal samples could be an acceptable alternative cervical screening method for older women. Offering this approach could increase screening uptake in older women who find conventional cervical screening to be less acceptable with ageing or the menopause.