Assessing the Acceptability of Home-Based HPV Self-Sampling: A Qualitative Study on Cervical Cancer Screening Conducted in Reunion Island Prior to the RESISTE Trial

SIMPLE SUMMARY: Reunion Island is a French overseas department where cervical cancer is 2 to 3 times more prevalent than in mainland France. Screening rates are lower, especially among women from disadvantaged socioeconomic backgrounds. The RESISTE research program aims to assess whether sending a self-sampling kit to women’s homes could improve screening uptake. Prior to the implementation of this program, qualitative research was conducted with women from various disadvantaged backgrounds, as well as health professionals, to measure knowledge levels, identify barriers and triggers to screening, and assess the acceptability of a home-based self-sampling methodology. The results demonstrate the interest of women and health professionals in this screening method, while also highlighting the need to (1) reassure women regarding usage and quality and (2) provide support and outreach. ABSTRACT: Cervical cancer incidence and mortality rates are 2 to 3 times higher in the overseas department of Reunion compared with mainland France. RESISTE’s cluster-randomized controlled trial aims to test the effectiveness of home-based self-sampling (HBSS) through a high-risk oncogenic papillomavirus test sent out by post to women who have not been screened in the past 3 years, despite having been invited to do so through a reminder letter. Prior to the trial, qualitative research was carried out to understand screening barriers and assess anticipated acceptability. Semi-structured interviews were conducted with 35 women and 20 healthcare providers. Providers consider HBSS a viable method in reaching women who tend not to visit a doctor regularly, or who are reluctant to undergo a smear pap, as well as those who are geographically isolated. They considered, however, that women would require support, and that outreach was necessary to ensure more socially isolated women participate. The majority of the women surveyed were in favour of HBSS. However, two-thirds voiced concerns regarding the test’s efficiency and their ability to perform the test correctly, without harming themselves. Based on these findings, recommendations were formulated to reassure women on usage and quality, and to help reach socially isolated women.