Understanding hesitancy: barriers to HR-HPV self-sampling among women at high risk for cervical cancer in Latvia

High-risk human papillomavirus (HR-HPV) is the leading cause of cervical cancer. Screening is one of the main cornerstones of cervical cancer prevention. Self-sampling for HR-HPV is introduced to improve patient involvement in the screening program. The study aimed to understand the hesitancy and barriers to self-sampling among high-risk women who are at risk of developing cervical cancer.

This qualitative study employed semi-structured telephone interviews to explore the factors behind the refusal of HR-HPV self-sampling among twelve purposefully selected women (aged 25-49) with abnormal Pap smears recruited from a colposcopy clinic within a major urban university hospital in Riga, Latvia. The interviews, conducted between June and September 2022, were transcribed verbatim and subjected to inductive content analysis.

Four inductive categories were developed and described: (1) 'Clinic visit-related distress' described patients' situational anxiety, fears, and during the visit to a healthcare facility that resulted in the refusal to take the HR-HPV self-sampling; (2) 'Health literacy challenges' highlighted patients' lack of knowledge and understanding of cervical cancer causation and screening role in the early detection of cervical cancer; (3) 'Doctor does and knows the best' explored patients' doubts and fears about the accuracy and comparability of HR-HPV self-sampling with conventional screening methods; (4) 'Circumstances that can promote taking the HR-HPV self-sampling' illuminated the circumstances that can encourage women to take the HR-HPV self-sampling.

A complex interplay of contextual factors contributed to the hesitancy of HR-HPV self-sampling in the group of women at high risk for cervical cancer, highlighting that women's decision-making regarding this procedure goes beyond its purely clinical aspects.