Barriers to acceptance of self-sampling for human papillomavirus across ethnolinguistic groups of women

Michelle Howard, Alice Lytwyn, Lynne Lohfeld, Lynda J Redwood-Campbell, Nancy C Fowler, Tina Karwalajtys

Research output: Contribution to journalArticlepeer-review

42 Citations (Scopus)


OBJECTIVES: Immigrant and low socio-economic (SES) women in North America underutilize Papanicolaou screening. Vaginal swab self-sampling for oncogenic human papillomavirus (HPV) has the potential to increase cervical cancer screening participation. The purpose of this qualitative study was to understand the perceptions of lower SES and immigrant women regarding self-sampling for HPV.

METHODS: Eleven focus-group interviews were conducted: one with Canadian-born English-speaking lower SES women, and two groups each with Arabic, Cantonese, Dari (Afghani), Somali and Spanish (Latino)-speaking women (one group conducted in English, the other in the native language) recently immigrated to Canada. Five to nine women aged 35 to 65 years and married with children participated in each group.

RESULTS: Themes included 1) who might use self-sampling and why; 2) aversion to self-sampling and reasons to prefer physician; 3) ways to improve the appeal of self-sampling. Women generally perceived benefits of self-sampling and a small number felt they might use the method, but all groups had some reservations. Reasons included: uncertainty over performing the sampling correctly; fear of hurting themselves; concern about obtaining appropriate material; and concerns about test accuracy. Women preferred testing by a health care professional because they were accustomed to pelvic examinations, it was more convenient, or they trusted the results.

CONCLUSIONS: Perceptions of self-sampling for HPV were similar across cultures and pertained to issues of confidence in self-sampling and need for physician involvement in care. These findings can inform programs and studies planning to employ self-sampling as a screening modality for cervical cancer.

Original languageEnglish
Pages (from-to)365-9
Number of pages5
JournalCanadian Journal of Public Health
Issue number5
Publication statusPublished - 10 Dec 2009


  • Adult
  • Aged
  • Canada
  • Emigrants and Immigrants
  • Female
  • Focus Groups
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility
  • Humans
  • Language
  • Middle Aged
  • Ontario
  • Papanicolaou Test
  • Papillomaviridae
  • Papillomavirus Infections
  • Papillomavirus Vaccines
  • Patient Acceptance of Health Care
  • Qualitative Research
  • Self Efficacy
  • Socioeconomic Factors
  • Uterine Cervical Neoplasms
  • Vaginal Smears
  • Journal Article
  • Research Support, Non-U.S. Gov't


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