Promoting cervical cancer screening via a mailed HPV self-collection kit: Reactions from screeners and non-screeners

Mailed human papillomavirus self-collection (HPV-SC) kits improve cervical cancer screening adherence; however, not all respond to kit invitations. This qualitative study sought to understand reactions to HPV-SC kit invitation among screeners and non-screeners in the STEP trial, a pragmatic trial offering kits.

Kaiser Permanente Washington patients randomized to the STEP trial's kit intervention arms, received educational materials and were notified they would receive a kit in one week (direct mail) or given information on how to request a kit (opt-in). Materials highlighted cancer risk, screening importance, test differences (Pap, HPV), and what to expect with abnormal results. Based on their screening status 6 months post-randomization, two categories of patients were invited for focus groups: 1) screeners with negative kit results or clinician-performed test; 2) non-screeners. We oversampled non-white patients. Six online focus groups were conducted from May to June 2022 with 40 patients (29 screeners, 11 non-screeners). A facilitator asked about HPV and cervical cancer knowledge, reaction to the kit and educational materials, and screening preference (self- vs. clinician-collected). Field notes and transcripts were analyzed by five coders using iterative content analysis.

Participants desired more flexibility during the invitation process, preferring multiple methods (mail, patient portal, text, in-clinic distribution) and support services (website, nurse-staffed phone). Educational resources acknowledging different learning styles (print, diagrams, audio-visual) and for specific populations (LGBTQ, monogamous) were suggested. Participants recommended clinicians reinforce kit efficacy to encourage use. Trust in the kit and in the health care system were key to ensure comfort with self-collection.

Multiple, diverse outreach strategies are needed to engage patients in screening with this new modality.

Flexible engagement by the healthcare system with comprehensive educational materials inclusive of diverse populations, and provider encouragement are needed to build patients' trust in, comfort with, and use of HPV-SC tests.

ClinicalTrials.gov Identifier: NCT04679675.