The co-creation of a document to guide the use of self-sampling for human papillomavirus screening in Italy

BackgroundVulnerable women face a higher risk of cervical cancer and reduced access to screening. Self-sampling may increase access to human papillomavirus screening. In this article, we report the co-creation of a document to guide the implementation of human papillomavirus self-sampling in Italy.MethodsWorking CollaBoratively with vulnerable women to Identify the best implementation Gains by SCREEning cervical cancer more effectively in European countries (CBIG-SCREEN) project, a Collaborative User Board has been set up in Italy, including national decision-makers, healthcare providers, and vulnerable women. To ensure that women's direct perspectives were incorporated into the process, informal individual interviews were carried out and brought to the Collaborative User Board meetings. The Collaborative User Board discussion was based on systematic reviews, screening program reports, and Italy's self-sampling pilots. Results were summarized with a matrix of vulnerable groups and barriers to evaluate interventions' potential ability to remove barriers. Considerations were collected in a document for screening program coordinators and decision-makers.ResultsThe Collaborative User Board identified major barriers to cervical cancer screening among different vulnerable groups and assessed five evidence-based strategies to address them: multilingual structured invitation letters, group training led by cultural mediators, training for healthcare professionals, training for third-sector operators, and self-sampling. Evaluating the potential of these strategies to remove barriers led to a focus on self-sampling. Mailing the device to all non-responders was the only strategy with sufficient evidence to increase participation in Italy. An opportunistic offer in a setting attended by vulnerable women is promising. The Collaborative User Board underscored the importance of improving healthcare providers' communication.ConclusionsThe final document, created through a transparent and collaborative bottom-up process, collects considerations for implementing self-sampling for human papillomavirus testing.