Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
School of Social Sciences, Bangor University, Bangor, UK.
Health Expect. 2017 Oct;20(5):1031-1040. doi: 10.1111/hex.12544. Epub 2017 Feb 10.
Testing for human papillomavirus (HPV) is being incorporated into the cervical screening programme, with the probable future introduction of HPV as a primary test and a possibility of HPV self-sampling. In anticipation of this development, we sought to inform future policy and practice by identifying potential barriers to HPV self-sampling.
A cross-sectional survey of 194 women aged 20-64 years was conducted. Logistic regression analysis was used to identify determinants of self-sampling intentions. A purposive subsample of 19 women who reported low self-sampling intentions were interviewed. Interviews were framework-analysed.
Most survey participants (N=133, 69.3%) intended to HPV self-sample. Lower intention was associated with lower self-efficacy (OR=24.96, P≤.001), lower education (OR=6.06, P≤.05) and lower perceived importance of HPV as a cause of cervical cancer (OR=2.33, P≤.05). Interviews revealed personal and system-related barriers. Personal barriers included a lack of knowledge about HPV self-sampling, women's low confidence in their ability to self-sample correctly and low confidence in the subsequent results. System-related factors included a lack of confidence in the rationale for modifying the current cervical screening programme, and concerns about sample contamination and identity theft.
Insights gained from this research can be used to guide further enquiry into the possibility of HPV self-sampling and to help inform future policy and practice. Personal and system-related barriers including low confidence in the reasons for changing current cervical screening provision need to be addressed, should HPV self-sampling be incorporated into the cervical screening programme.
人乳头瘤病毒（HPV）检测正被纳入宫颈筛查计划，未来可能会将 HPV 作为主要检测手段，并可能实现 HPV 自我采样。有鉴于此，我们希望通过确定 HPV 自我采样的潜在障碍，为未来的政策和实践提供信息。
我们对 194 名 20-64 岁的女性进行了横断面调查。采用逻辑回归分析确定自我采样意向的决定因素。对报告自我采样意向较低的 19 名女性进行了目的抽样访谈。对访谈进行了框架分析。
大多数调查参与者（N=133，69.3%）打算进行 HPV 自我采样。较低的意向与较低的自我效能感（OR=24.96，P≤.001）、较低的教育程度（OR=6.06，P≤.05）和较低的 HPV 作为宫颈癌病因的重要性认知（OR=2.33，P≤.05）相关。访谈揭示了个人和系统相关的障碍。个人障碍包括对 HPV 自我采样缺乏了解、女性对自己正确自我采样能力的信心不足以及对后续结果的信心不足。系统相关因素包括对修改当前宫颈筛查计划的基本原理缺乏信心，以及对样本污染和身份盗用的担忧。
本研究获得的见解可用于指导进一步研究 HPV 自我采样的可能性，并有助于为未来的政策和实践提供信息。如果将 HPV 自我采样纳入宫颈筛查计划，需要解决与个人和系统相关的障碍，包括对改变当前宫颈筛查服务提供的原因缺乏信心。
