Barriers to cervical cancer screening and experiences using mailed at-home HPV self-collection kits among US and foreign-born Hispanic women in a safety net health system.

OBJECTIVE

Mailed self-collection for human papillomavirus (HPV) testing can increase cervical cancer screening among underscreened women, though barriers differ by subgroup. Hispanic/Latina women, especially foreign-born, have lower screening rates than non-Hispanic white women. This study compared barriers to Papanicolaou (Pap) screening and experiences with mailed HPV self-collection among underscreened foreign-born Hispanic, US-born Hispanic, and US-born non-Hispanic women in a safety-net health system.

METHODS

We analyzed survey data from a randomized trial of mailed HPV self-collection among women aged 30-65 years who were overdue for screening. Participants received an at-home kit and completed a telephone survey in English/Spanish. Barriers and experiences were compared using chi-squared tests.

RESULTS

Of 256 participants, 64.1% were foreign-born Hispanic, 12.1% US-born Hispanic, and 23.8% US-born non-Hispanic. Foreign-born Hispanic women had increased prevalence of self-reported barriers to Pap screening-including discomfort with male providers, embarrassment, pain, appointment and transportation difficulties, uncertainty about screening intervals, and fear of cancer or HPV. Experiences with self-collection were similar across all groups: most participants reported a good experience, a willingness to use it again, and a willingness to recommend it. However, foreign-born Hispanic women were more likely to express concerns about proper sample collection, safety, and confidentiality.

CONCLUSIONS

Barriers to traditional cervical cancer screening across several categories, including discomfort and embarrassment, lack of knowledge or healthcare access, and fear of cancer, were more prevalent among foreign-born Hispanic women than among the other groups. While experiences with self-collection were generally positive across the three groups, the prevalence of barriers was higher among foreign-born Hispanic women.