Qualitative insights into the acceptability of self-collection for cervical screening amongst under- and...

Since 2022, Australia's National Cervical Screening Program has recommended that anyone eligible for cervical screening should be offered the choice of HPV testing on either a self-collected vaginal sample, or a clinician-collected sample. This choice provides the potential to address some screening barriers for under- and never-screened women and people with a cervix. In this qualitative study we aimed to understand the acceptability of self-collection for individuals from under-and never-screened groups, and its potential to improve equitable access to screening through the national program.

Fifty-five semi-structured interviews were conducted between October 2023-November 2024 with screen-eligible women and people with a cervix from the LGBTQ+ community, refugee backgrounds, Pacific Islander communities, and those with physical and/or sensory disability. Data were thematically analysed using the Theoretical Framework of Acceptability.

Most participants had a positive view of self-collection and could see its benefits, particularly its capacity to increase privacy and autonomy. Self-collection was seen as beneficial for those who experienced issues related to body shyness and discomfort about being undressed in front of healthcare providers. Participants placed high value on having options for cervical screening; however, many preferred clinician-collection due to low self-efficacy in collecting a sample themselves and concerns about the accuracy of the test. Additionally, some participants with physical and/or sensory disabilities highlighted dexterity and/or mobility challenges that made self-collection difficult or the swab difficult to use. Participants agreed there was a need for community-tailored information sessions and broader campaigns about self-collection as many communities were still unaware of this option.

While self-collection has the potential to expand screening accessibility and may offer individual benefits, increased awareness of its availability and attention to identified barriers are needed to ensure that everyone is given true choice in the way they screen.