At-home self-sampling cervical screening looks likely to be an option in the future. But scientists warn that steps must be taken to ensure that the offer of at-home sampling doesn’t have a negative impact on cervical screening rates and that they are used by underserved and at-risk groups.

New research published in Health Expectations by Cardiff University establishes the communication strategies needed if HPV at-home self-sampling is offered as a choice for cervical screening, to increase trust in the process and patient participation.

Dr. Denitza Williams, from Cardiff University’s School of Medicine, said, “Cervical screening uptake has steadily declined in the UK over the last decade at 69.6%—remaining under the target of 80%, which is needed to reduce the incidence of cervical cancer.

“Embarrassment, body image concerns, lack of available appointments, cultural sensitivity and time to attend are common barriers to cervical screening. Self-sampling HPV screenings that can be done at home could reduce these barriers, as it allows HPV sampling to be taken by the person themselves at home or another preferred location.

“As self-sampling is being prepared to be possibly rolled out in the UK, it’s important that we understand how to best communicate this new option with individuals for the best delivery and uptake.”

In the SUCCEED study, the researchers aimed to develop evidence-based recommendations for a communication strategy to support individuals when choosing between HPV self-sampling or clinician HPV sampling.

The study is the first to combine behavior change and decision support theory to inform a communication strategy to facilitate informed decision-making for cervical screenings.

“It is important that, prior to the roll-out of self-sampling for cervical screening, we fully understand how self-sampling can address some of the barriers to traditional clinician sample collection, but also how it could present unique barriers,” added Dr. Williams.

The study explored knowledge, values and preferences among cervical screening responders, and those who have traditionally not taken up the screening invitation—including looking at age, socioeconomic group, ethnicity, gender identity and sexual orientation.

“The introduction of HPV self-sampling as a choice for individuals in the UK needs to be supported by a robust communication strategy. This is vital in increasing public awareness and engagement. This must also be accompanied by decision support to facilitate informed decision-making when individuals are provided with a choice,” says Williams.

The research highlighted that while participants were positive about the possibility of self-sampling for cervical screening, there is also some skepticism about the reasoning behind the offer of choice, a perceived lack of transparency about the benefits of self-sampling and confusion around the effectiveness of self-sampling.

The researchers also uncovered a general lack of understanding of cervical screening, with low levels of knowledge about HPV making the offer of choice hard to compare. Individuals also reported concern over the accuracy of results when self-sampling.

“We need to ensure that all of our findings are addressed in communications in the lead-up to self-sampling cervical screenings being rolled out. We must also ensure that there is tailored content for communities and individuals, such as those who have been through sexual violence, immigrants, and certain religious and LGBTQ+ groups,” added Dr. Clarke, research assistant on the SUCCEED study.

This work expands on their previous research, which found that directly mailing HPV self-sampling kits to individuals from low socioeconomic status groups, ethnic minority groups, and older women has the potential to increase the uptake of HPV self-sampling for cervical screening.

Dr. Williams said, “This study sets out the pathway for the creation of a communication campaign for supporting decisions in the lead-up to self-sampling becoming available for individuals in the UK. We highlight the best course of action to communicate with individuals, to ensure that individuals are aided to make the right choice for them when it comes to cervical screening—to attend a traditional clinic or self-sample at home.

“We hope that through the introduction of choice for individuals, and supporting introduction with a communication strategy, that we will empower individuals to make the best health care choices for themselves, but we can also increase the numbers going for cervical screenings—particularly among groups who are less likely to engage with screenings or are put off.”

“With any change to established ways of doing screening, it is incredibly important for health care organizations to communicate clearly so that people continue to engage with screening. This study led by Cardiff University researchers gives important insights into how best to support informed choices about cervical screening, so that cervical cancer can be found early in more people,” says Professor Katherine Brain.