Completing the cervical screening pathway: Factors that facilitate the increase of self-collection uptake among under-screened and never-screened women, an Australian pilot study

Abstract

Objectives To examine factors that enhance under-screened and never-screened women’s completion of the self-collection alternative pathway of the Renewed National Cervical Screening Program (NCSP) in Victoria, Australia. Background With the Australian NCSP changing, starting on 1 December 2017, the Medical Services Advisory Committee (MSAC) recommended implementing human papillomavirus (HPV) testing using a self-collected sample for under-screened and never-screened populations. In response, a multi-agency group implemented an HPV selfcollection pilot project to trial self-collection screening pathways for eligible women. Methods Quantitative data were collected on participation rates and compliance rates with follow-up procedures across three primary health care settings. Forty women who self-collected were interviewed in a semi-structured format, and seven agency staff completed in-depth interviews. Qualitative data were used to identify and understand clinical and personal enablers that assisted women to complete self-collection cervical screening pathways successfully. Results Eighty-five per cent (10 women) of participants who tested positive for HPV successfully received their results and completed follow-up procedures as required. Two remaining participants also received HPV-positive results. However, agencies were unable to engage them in follow-up services and procedures. The overall participation rate in screening (self-collection or Pap test) was 85.7% (84 women), with 79 women self-collecting. Qualitative data indicated that clear explanations on self-collection, development of trusting, empathetic relationships with health professionals, and recognition of participants’ past experiences were critical to the successful completion of the self-collection pathway. When asked about possible inhibitors to screening and to following up on results and appointments, women cited poor physical and mental health, as well as financial and other structural barriers. Conclusion A well-implemented process, led by trusted, knowledgeable, and engaged health care professionals who can provide appropriate support and information, can assist under-screened and never-screened women to complete the HPV self-collection pathway successfully.