Acceptability of HPV self-sampling in three urban academic emergency departments

Cervical cancer disparities exist among vulnerable populations, with over half of cases diagnosed in women who rarely or never screen. Emergency departments (EDs) may be an effective site to reach patients overdue for cancer screening, especially using human papillomavirus (HPV) self-sampling, where women use a swab to collect their own cervicovaginal sample. We surveyed women eligible for cervical cancer screening in three EDs to determine patient acceptability and preferences for HPV self-sampling in the ED to inform an ED-based prevention intervention.

This was a cross-sectional survey study of 30-65-year-old women presenting to three EDs in 2024 and 2025 with non-critical conditions, who spoke English or Spanish, and had no history of hysterectomy. Research assistants actively recruited in the ED using convenience sampling with interested patients. They provided brief education on how self-sampling is performed prior to conducting the survey.

Of 359 women, 84% were somewhat or very willing to use a HPV self-sampling kit if offered in the ED, 91% were somewhat or very confident in their ability to collect their sample correctly, and 76% were somewhat or very comfortable using the self-sampling kit in an ED bathroom. Over half (58%) would prefer to complete self-sampling rather than have collection completed by a physician or nurse. Participants in the oldest age group (60-65-year-olds) (OR = 3.11; 95% CI = 1.28,7.57) and participants with Medicaid (OR = 1.69; 95% CI = 0.95,3.03) were more willing to use self-sampling if it was offered compared to the youngest participants (30-39-year-olds) and those with private insurance, respectively. The most prevalent concerns of using the test were: that the test was not done right (47%) and not knowing how to perform the test (26%).

Our survey showed strong patient willingness, confidence, and comfort with HPV self-sampling in the ED, with over half of participants preferring self-sampling over traditional collection by a clinician. EDs interested in starting a HPV self-sampling program should consider ways to engage younger and non-Medicaid patients who were less willing to self-sample in the ED. Concerns around not performing the test correctly highlight the need for clear instructions for self-sampling.