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Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study.
BMC Cancer. 2017 Nov 09; 17(1):734.BC

Abstract

BACKGROUND

Data is needed about barriers to self-collection of Human Papillomavirus (HPV) samples and cytology among low-income, disadvantaged women living in rural areas of lower-income countries as these women are at increased risk of cervical cancer mortality.

METHODS

Individual interviews (n = 29), focus groups (n = 7, 5-11 participants) and discussion groups (n = 2, 18-25 participants) were organized with women from three indigenous ethnic groups residing in rural areas in Mexico, after they were provided with free, self-sampled HPV tests. These groups are low-income, underserved by healthcare and have historically been on the receiving end of racism and social exclusion. Descriptive, qualitative content analysis was done, including two cycles of coding.

RESULTS

Interview and focus/discussion group data indicate women had limited understanding of HPV's role in cervical cancer etiology. They identified HPV's existence, that cytology detects cervical cancer, the need for regular testing and that cervical cancer is sexually transmitted. Organizational barriers to clinic-based cytology included irregular supplies of disposable speculums, distance to clinics and lack of clear communication by healthcare personnel. Women considered self-collected HPV-testing easy, less embarrassing and less painful than cytology, an opportunity for self-care and most felt they understood how to take a self-sample after a 20-min explanation. Some women feared hurting themselves when taking the self-sample or that they would take the sample incorrectly, which they worried would make the test useless. Attending HPV-testing in groups facilitated use by allowing women to discuss their doubts and fears before doing self-collection of the sample or to ask other women who were the first to do the self-sampling what the experience had been like (whether it hurt and how easy it was). Lack of indoor bathrooms was a barrier to doing HPV self-sampling at home, when those homes were resource-poor (one-room dwellings).

CONCLUSIONS

Low-income, indigenous Mexican women residing in rural, underserved areas identified their need for cervical cancer screening but encountered multiple barriers to cytology-based screening. They found a number of advantages of HPV self-sampled tests. Employing self-collected HPV-testing instead of cytology could resolve some but not all gender-related, organizational or technical quality-of-care issues within cervical cancer detection and control programs.

Authors+Show Affiliations

Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico.National Center for the Prevention and Control of HIV and AIDS (CENSIDA), Mexico City, Mexico.CONACYT, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.Center for Healthy Communities, Department of Social Medicine and Population Health, UCR School of Medicine, UC Irvine, Riverside, California, USA.Center for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.Center for Population Health Research, National Institute of Public Health, Av. Universidad #655, Colonia Sta. Ma. Ahuacatitlán, 62508, Cuernavaca, Morelos, Mexico. Epidemiology and Health Services Research Unit, Mexican Social Security Institute (IMSS), Cuernavaca, Morelos, Mexico.Center for Population Health Research, National Institute of Public Health, Av. Universidad #655, Colonia Sta. Ma. Ahuacatitlán, 62508, Cuernavaca, Morelos, Mexico. elazcano@insp.mx.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29121873

Citation

Allen-Leigh, Betania, et al. "Barriers to HPV Self-sampling and Cytology Among Low-income Indigenous Women in Rural Areas of a Middle-income Setting: a Qualitative Study." BMC Cancer, vol. 17, no. 1, 2017, p. 734.
Allen-Leigh B, Uribe-Zúñiga P, León-Maldonado L, et al. Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study. BMC Cancer. 2017;17(1):734.
Allen-Leigh, B., Uribe-Zúñiga, P., León-Maldonado, L., Brown, B. J., Lörincz, A., Salmeron, J., & Lazcano-Ponce, E. (2017). Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study. BMC Cancer, 17(1), 734. https://doi.org/10.1186/s12885-017-3723-5
Allen-Leigh B, et al. Barriers to HPV Self-sampling and Cytology Among Low-income Indigenous Women in Rural Areas of a Middle-income Setting: a Qualitative Study. BMC Cancer. 2017 Nov 9;17(1):734. PubMed PMID: 29121873.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study. AU - Allen-Leigh,Betania, AU - Uribe-Zúñiga,Patricia, AU - León-Maldonado,Leith, AU - Brown,Brandon J, AU - Lörincz,Attila, AU - Salmeron,Jorge, AU - Lazcano-Ponce,Eduardo, Y1 - 2017/11/09/ PY - 2016/08/22/received PY - 2017/10/30/accepted PY - 2017/11/11/entrez PY - 2017/11/11/pubmed PY - 2018/6/21/medline KW - Barriers to detection KW - Cervical cancer KW - Cytology KW - HPV test KW - Low-income KW - Middle-income nations KW - Qualitative methodology KW - Rural residence KW - Self-sample KW - Underserved SP - 734 EP - 734 JF - BMC cancer JO - BMC Cancer VL - 17 IS - 1 N2 - BACKGROUND: Data is needed about barriers to self-collection of Human Papillomavirus (HPV) samples and cytology among low-income, disadvantaged women living in rural areas of lower-income countries as these women are at increased risk of cervical cancer mortality. METHODS: Individual interviews (n = 29), focus groups (n = 7, 5-11 participants) and discussion groups (n = 2, 18-25 participants) were organized with women from three indigenous ethnic groups residing in rural areas in Mexico, after they were provided with free, self-sampled HPV tests. These groups are low-income, underserved by healthcare and have historically been on the receiving end of racism and social exclusion. Descriptive, qualitative content analysis was done, including two cycles of coding. RESULTS: Interview and focus/discussion group data indicate women had limited understanding of HPV's role in cervical cancer etiology. They identified HPV's existence, that cytology detects cervical cancer, the need for regular testing and that cervical cancer is sexually transmitted. Organizational barriers to clinic-based cytology included irregular supplies of disposable speculums, distance to clinics and lack of clear communication by healthcare personnel. Women considered self-collected HPV-testing easy, less embarrassing and less painful than cytology, an opportunity for self-care and most felt they understood how to take a self-sample after a 20-min explanation. Some women feared hurting themselves when taking the self-sample or that they would take the sample incorrectly, which they worried would make the test useless. Attending HPV-testing in groups facilitated use by allowing women to discuss their doubts and fears before doing self-collection of the sample or to ask other women who were the first to do the self-sampling what the experience had been like (whether it hurt and how easy it was). Lack of indoor bathrooms was a barrier to doing HPV self-sampling at home, when those homes were resource-poor (one-room dwellings). CONCLUSIONS: Low-income, indigenous Mexican women residing in rural, underserved areas identified their need for cervical cancer screening but encountered multiple barriers to cytology-based screening. They found a number of advantages of HPV self-sampled tests. Employing self-collected HPV-testing instead of cytology could resolve some but not all gender-related, organizational or technical quality-of-care issues within cervical cancer detection and control programs. SN - 1471-2407 UR - https://www.unboundmedicine.com/medline/citation/29121873/Barriers_to_HPV_self_sampling_and_cytology_among_low_income_indigenous_women_in_rural_areas_of_a_middle_income_setting:_a_qualitative_study_ L2 - https://bmccancer.biomedcentral.com/articles/10.1186/s12885-017-3723-5 DB - PRIME DP - Unbound Medicine ER -