Esber Allahna, McRee Annie-Laurie, Norris Turner Abigail, Phuka John, Norris Alison
Doctoral Candidate, Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
Assistant Professor, Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
J Fam Plann Reprod Health Care. 2017 Apr;43(2):135-141. doi: 10.1136/jfprhc-2015-101305. Epub 2016 Mar 4.
Malawi has the highest incidence of cervical cancer in the world. Only 3% of Malawian women have ever been screened for cervical cancer. Self-collection of samples for human papillomavirus (HPV) testing could increase screening among under-screened and hard-to-reach populations. However, little is known about the acceptability of self-collection in rural African settings.
We aimed to characterise Malawian women's willingness to self-collect vaginal samples for HPV testing and to identify potential barriers.
We used data from the baseline wave of a community-based cohort study, collected from July 2014 to February 2015.
Participants were enrolled from the catchment area of a clinic in rural Lilongwe District, Malawi.
We enrolled women aged 15-39 years (=824). Participants answered questions assessing willingness to self-collect a sample for HPV testing, concerns about testing and other hypothesised correlates of willingness to self-collect.
Two-thirds (67%) of the women reported willingness to self-collect a vaginal sample in their homes. Awareness of cervical cancer, supportive subjective norms, perceived behavioural control, and clinician recommendations were all positively associated with increased willingness to self-collect samples for HPV testing. Identified barriers to self-testing endorsed by women included: concerns that the test might hurt (22%), that they might not do the test correctly (21%), and that the test might not be accurate (17%).
This study suggests that self-collection for HPV testing could be an acceptable cervical cancer screening method in this rural population. Findings identify modifiable beliefs and barriers that can inform the development of effective screening programmes.
马拉维是世界上宫颈癌发病率最高的国家。仅有3%的马拉维女性曾接受过宫颈癌筛查。自行采集人乳头瘤病毒（HPV）检测样本可增加筛查不足和难以触及人群的筛查率。然而，在非洲农村地区，对于自行采集样本的可接受性知之甚少。
我们旨在了解马拉维女性自行采集阴道样本进行HPV检测的意愿，并确定潜在障碍。
我们使用了一项基于社区的队列研究基线期的数据，该数据于2014年7月至2015年2月收集。
参与者来自马拉维利隆圭区农村一家诊所的服务区域。
我们招募了15 - 39岁的女性（n = 824）。参与者回答了有关自行采集HPV检测样本的意愿、对检测的担忧以及其他假设的自行采集意愿相关因素的问题。
三分之二（67%）的女性表示愿意在家中自行采集阴道样本。对宫颈癌的认知、支持性主观规范、感知行为控制和临床医生的建议均与自行采集HPV检测样本的意愿增加呈正相关。女性认可的自行检测的障碍包括：担心检测会疼痛（22%）、担心自己操作不正确（21%）以及担心检测不准确（17%）。
本研究表明，自行采集HPV检测样本可能是该农村人群可接受的宫颈癌筛查方法。研究结果确定了可改变的观念和障碍，可为制定有效的筛查计划提供参考。
