Self-collection for vaginal human papillomavirus testing: systematic review of studies asking women their perceptions

To systematically review literature on women's acceptance, preference, willingness, and attitudes toward human papillomavirus DNA vaginal self-sampling and assess study validity using the STROBE statement.

From September to October 2008, Ovid MEDLINE, EMBASE, and CINAHL databases were searched systematically over all years available. Participants were women who either completed vaginal self-sampling or were described the procedure. Studies were required to report women's acceptance, preference, willingness or attitudes toward self-sampling. Two independent reviewers assessed abstracts and articles for inclusion and collected study data. Disagreements were resolved by consensus.

Twenty studies were included. Of 8 studies, 7 reported that women found self-sampling acceptable. Of the 13 studies, 8 found that more women (63%-94%) preferred self-sampling to clinician-collected sampling. Most women were also receptive to self-sampling as part of future screening. Common opinions expressed by women included an uncertainty if they had or could perform the self-test properly and greater confidence in clinician sampling. Only 2 studies used questionnaires that had been validated, and selection bias favoring self-sampling could not be ruled out in most studies.

Vaginal human papillomavirus DNA self-sampling is generally well received among women. However, the possibility of selection bias and survey instrument measurement error may have led to an overestimate of women's favorable opinions for self-sampling. A self-sampling option may increase screening coverage, but concerns of women must also be addressed.