Underscreened Women's Reactions to At-Home Self-Collected Human Papillomavirus Test Result Delivery

Mailed self-collection kits for high-risk human papillomavirus (HPV) detection can increase access to cervical cancer screening among underscreened women. To design effective screening programs, it is necessary to evaluate women's understanding, reactions, and preferences for self-collected HPV test result delivery.

The My Body, My Test-3 trial assessed the effectiveness of mailed HPV self-collection kit outreach. Between 2016 and 2019, the trial enrolled low-income women aged 25 to 64 years in North Carolina overdue for cervical cancer screening. Our analytical sample included women from the intervention arm who conducted at-home self-collection, returned a self-collection kit, had a conclusive HPV result, and completed a follow-up survey after results were received by phone but before in-clinic screening. We evaluated women's understanding, reactions, and preferences for result delivery, stratified by result positivity.

Among 296 diverse, low-income women, 16% (n = 47/296) had an HPV-positive result and 84% (n = 249/296) had an HPV-negative result. Most women understood their results as an indicator of cervical cancer risk, and 93% (n = 264/284 who responded) correctly recalled their results 1 week post-receipt. Women with a positive result more frequently reported feeling afraid and worried, and less frequently reported feeling relieved, compared with those with a negative result (all P < 0.001). Most women were comfortable receiving results by phone (HPV-positive result: 85%, n = 40/47; HPV-negative result: 96%, n = 238/249), although some with a positive result had remaining questions.

Although most women delivered their mailed, self-collected HPV result by phone understood their result, future US screening programs should provide educational support during and after HPV-positive result delivery.