What are the views and experiences of human papillomavirus (HPV) self-sampling for cervical screening in high-income countries? A qualitative systematic review using the Theoretical Domains Framework.

BACKGROUND

Worldwide, cervical cancer is the fourth most common cancer in women. Screening reduces cervical cancer mortality through detection of early-stage cancers and identification and treatment of precancers. Human papillomavirus (HPV) self-sampling is a novel addition to clinician-collected sampling that may help increase screening uptake. This systematic review aimed to assess the views and experiences of HPV self-sampling in high-income countries populations at varying stages of self-sampling implementation.

METHODS

Systematic searches were conducted in PubMed, PsycINFO, EMBASE, and CINAHL in April 2024. Qualitative and mixed-methods studies were included. The findings were mapped to the specific domains of the Theoretical Domains Framework (TDF). Study quality was assessed using the qualitative CASP checklist.

FINDINGS: Thirty-six studies were included. The review identified 19 sub-categories within the TDF (13 initial domains and 6 subcategories in the "environmental context and resources domain"). The most commonly identified themes, reflecting both positive and negative views and experiences of self-sampling, related to the following TDF categories: "knowledge"; "skills"; "beliefs about capabilities" (concerns about performing the self-test correctly); "beliefs about consequences" (concerns about test reliability); "intentions"; "social influences" (religion, cultural beliefs); "emotions" (fear, embarrassment) and "environmental context and resources" (autonomy, privacy, convenience). In the latter, previous negative experiences with procedures performed by providers were often reported, enhancing the interest for self-sampling.

DISCUSSION: The findings can inform and help to adapt or modify the implementation of HPV self-sampling by anticipating the needs of and challenges faced by the eligible populations. Clear instructions on how to perform the test should be provided. While the findings suggest that providing multiple methods for accessing the kit (e.g., by mail or in clinics) may be optimal, further research is needed to assess feasibility.