Center for Microbiology Research, Kenya Medical Research Institute, P. O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya.
Duke Global Health Institute, Box 90519, 310 Trent Drive, Durham, NC, 27710, USA.
BMC Womens Health. 2019 Jun 13;19(1):75. doi: 10.1186/s12905-019-0778-2.
Despite cervical cancer being preventable with effective screening programs, it is the most common cancer and the leading cause of cancer-related death among women in many countries in Africa. Screening involving pelvic examination may not be feasible or acceptable in limited-resource settings. We sought to evaluate women's perspectives on human papillomavirus (HPV) self-sampling as part of a larger trial on cervical cancer prevention implementation strategies in rural western Kenya.
We invited 120 women participating in a cluster randomized trial of cervical cancer screening implementation strategies in Migori County, Kenya for in-depth interviews. We explored reasons for testing, experience with and ability to complete HPV self-sampling, importance of clinician involvement during screening, factors and people contributing to screening decision-making, and ways to encourage other women to come for screening. We used validated theoretical frameworks to analyze the qualitative data.
Women reported having positive experiences with the HPV self-sampling strategy. The factors facilitating uptake included knowledge and beliefs such as prior awareness of HPV, personal perception of cervical cancer risk, desire for improved health outcomes, and peer and partner encouragement. Logistical and screening facilitators included confidence in the ability to complete HPV self-sampling strategy, proximity to screening sites and feelings of privacy and comfort conducting the HPV self- sampling. The barriers to screening included fear of need for a pelvic exam, fear of disease and death associated with cervical cancer. We classified these findings as capabilities, opportunities and motivations for health behavior using the COM-B framework.
Overall, HPV self-sampling was an acceptable cervical cancer screening strategy that seemed to meet the needs of the women in this community. These findings will further inform aspects of implementation, including outreach messaging, health education, screening sites and emphasis on availability and effectiveness of preventative treatment for women who screen positive.
尽管有效的筛查计划可以预防宫颈癌，但在许多非洲国家，宫颈癌仍是最常见的癌症，也是癌症相关死亡的主要原因。在资源有限的情况下，盆腔检查等筛查方式可能并不可行或无法被接受。我们旨在评估女性对人乳头瘤病毒（HPV）自我采样的看法，这是肯尼亚西部农村地区宫颈癌预防实施策略的一项更大规模试验的一部分。
我们邀请了参加肯尼亚米戈里县宫颈癌筛查实施策略的一项集群随机试验的 120 名女性进行深入访谈。我们探讨了进行检测的原因、HPV 自我采样的经验和能力、筛查过程中临床医生参与的重要性、影响筛查决策的因素和人员，以及鼓励其他女性来筛查的方法。我们使用了经过验证的理论框架来分析定性数据。
女性报告对 HPV 自我采样策略有积极的体验。促进采用的因素包括知识和信念，例如对 HPV 的事先了解、个人对宫颈癌风险的认知、对改善健康结果的渴望，以及同伴和伴侣的鼓励。便于接受筛查的因素包括对完成 HPV 自我采样策略的能力有信心、筛查点的位置便利以及进行 HPV 自我采样时感到隐私和舒适。筛查的障碍包括对需要进行盆腔检查的恐惧、对与宫颈癌相关的疾病和死亡的恐惧。我们使用 COM-B 框架将这些发现归类为健康行为的能力、机会和动机。
总体而言，HPV 自我采样是一种可以接受的宫颈癌筛查策略，似乎满足了该社区女性的需求。这些发现将进一步为实施方面提供信息，包括外展信息传递、健康教育、筛查点，以及强调为筛查呈阳性的女性提供预防治疗的可用性和有效性。
