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Acceptability and ease of use of mailed HPV self-collection among infrequently screened women in North Carolina
  1. Chelsea Anderson1,
  2. Lindsay Breithaupt1,
  3. Andrea Des Marais1,
  4. Charlotte Rastas2,
  5. Alice Richman3,
  6. Lynn Barclay4,
  7. Noel T Brewer1,5,
  8. Jennifer S Smith1,5
  1. 1 Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
  2. 2 School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
  3. 3 College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
  4. 4 American Sexual Health Association, Chapel Hill, North Carolina, USA
  5. 5 University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Jennifer S Smith, Department of Epidemiology, 2103 McGavran-Greenberg, Department of Epidemiology, UNC Gillings School of Global Public Health, Campus Box 7435, Chapel Hill, NC 27599, USA; jennifers{at}


Objectives Self-collection of cervico-vaginal samples for human papillomavirus (HPV) testing has the potential to make cervical cancer screening more accessible to underscreened women. We evaluated the acceptability and ease of use of home-based HPV self-collection within a diverse population of low-income, infrequently screened women.

Methods Participants were low-income women from North Carolina who had not received Pap testing in 4 or more years. Eligible women received a self-collection kit containing instructions and a brush for home-based sample collection. A total of 227 women returned a self-collected sample by mail and completed a questionnaire to assess their experiences with HPV self-collection. We described acceptability measures and used logistic regression to identify predictors of overall positive thoughts about the self-collection experience.

Results Nearly all women were willing to perform HPV self-collection again (98%) and were comfortable receiving the self-collection kit in the mail (99%). Overall, 81% of participants reported positive thoughts about home-based self-collection. Women with at least some college education and those who were divorced, separated or widowed were more likely to report overall positive thoughts. Aspects of self-collection that participants most commonly reported liking included convenience (53%), ease of use (32%) and privacy (23%). The most frequently reported difficulties included uncertainty that the self-collection was done correctly (16%) and difficulty inserting the self-collection brush (16%).

Conclusions Home-based self-collection for HPV was a highly acceptable screening method among low-income, underscreened women and holds the promise to increase access to cervical cancer screening in this high-risk population.

  • cervical neoplasia
  • HPV
  • screening
  • Uterine cervical neoplasms
  • early detection of cancer
  • papillomavirus infections
  • United States
  • female
  • humans

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  • Handling editor Jackie A Cassell

  • Competing interests JSS has received research supplies, grants and consultancies from Hologic, Becton Dickinson, Rovers Medical Devices, and Trovagene over the past 5 years.

  • Ethics approval University of North Carolina Institutional Review Board (IRB no. 08-2099).

  • Provenance and peer review Not commissioned; externally peer reviewed.