Rural women choose self-sampling over a pelvic exam for cervical cancer screening: a mixed-method study

Abstract

Background: Barriers to cervical cancer screening are significantly higher among US rural populations. To understand these barriers and explore potential remedies, we compare perceptions of screening exam techniques, pelvic exam vs. self-sampling, and how perceptions vary by participants' beliefs, physician characteristics, and known barriers among under-screened rural people in Michigan, United States.

Methods: Our mixed-methods study explored experiences with a vaginal self-sampling technique in comparison to the memory of the most recent pelvic exam. We developed quantitative survey questions using Health Information National Trends Survey (HINTS) modules. We created the qualitative interview guide using Likert scales and the Theoretical Domains Framework (TDF). We provided vaginal self-sampling kits (HerSwab) to participants to try this new test modality. We used descriptive statistics and t tests to analyze quantitative data. We analyzed the interview responses thematically.

Results: Of the forty rural white women who shared their experiences of the two screening techniques, the pelvic exam technique had significantly worse negative ratings across all fourteen perceptions than the self-sampling technique, and the self-sampling technique had significantly higher positive ratings. Analysis of interviews revealed four themes that elaborated survey results: 1) preference for the self-sampling technique; 2) physical and emotional discomfort with the pelvic exam technique; 3) convenience of the self-sampling technique; and 4) empowerment through self-sampling.

Conclusions: The powerful negative perceptions of the pelvic exam may be why people do not participate in screening. The self-sampling cervical cancer screening technique offers a quick and easy method for screening that many prefer.

Keywords: Cervical cancer screening; Pelvic exam; Rural.