Acceptability to Healthcare Professionals of Home-Based HPV Self-Sampling for Cervical Screening: A French Qualitative Study Conducted in an Area with Low Access to Health Services

SIMPLE SUMMARY: Cervical cancer is an important and preventable disease. Logistical, financial, organizational, and psychological barriers must be addressed to reach adult women not attending screening. The present qualitative study examined these barriers for women and explored effective screening strategies in areas of France with fewer doctors and suboptimal access to health facilities. Healthcare professionals were interviewed on the advantages and disadvantages of mailing vaginal or urine self-sampling kits. Self-sampling has been shown to be an effective tool for reaching underscreened women. Our survey highlighted several items that need to be considered in future screening programs that will include self-sampling: (1) development of clear user instructions, (2) choice of an effective and acceptable self-sampling device (vaginal or urine), (3) involvement of health professionals, and (4) support for women (information about the sequence of events (collection, results communication, and follow-up of screen-positive patients)). ABSTRACT: Self-sampling may improve participation in cervical cancer secondary prevention programs by women who do not respond or respond irregularly when invited to contact a health professional for the collection of a cervical specimen. It could also help resolve access problems in areas with a low physician density. The present qualitative study examined barriers to screening, effective screening strategies, and the advantages and disadvantages of sending women urine or vaginal self-sampling kits in two medically underserved administrative departments in France (Mayenne and Sarthe) showing low cervical screening coverage. As part of the CapU4 randomized trial, a team of psychologists investigated the attitudes and experiences of 59 healthcare professionals (gynecologists, general practitioners, and midwives) through semi-structured interviews. Results indicated that health professionals believe that self-sampling may address the issues of low physician density and underscreening by removing logistical, organizational, financial, and psychological obstacles. They confirmed trust in the use of vaginal self-sampling, with urine self-sampling as an alternative solution (e.g., for women with vaginismus). The health professionals also identified several limitations of the self-sampling kit that will need to be addressed in future screening campaigns (incomplete kit, complex instructions, poor anatomical knowledge, and obesity).