Acceptability of self-sampling for high-risk HPV DNA testing for primary cervical cancer screening among women in Thyolo, Malawi: A qualitative study.

IF 2.5
PLOS global public health Pub Date : 2025-09-24 eCollection Date: 2025-01-01 DOI:10.1371/journal.pgph.0004763
Hussein H Twabi, Wakumanya Sibande, Owen Mhango, Takondwa Charles Msosa, Chikumbutso Chipandwe, Madalo Mukoka, Moses Kumwenda, Vanitha Sivalingam, Dennis Solomon, Chisomo Msefula, David Lissauer, Marriott Nliwasa, Maria Lisa Odland
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Abstract

Despite the roll-out of cervical cancer screening within routine health facilities, uptake of cervical cancer screening in Malawi remains low due to factors such as privacy concerns, stigma, and distance to health facility. Self-sampling for human papillomavirus (HPV) testing offers a viable alternative to provider-delivered sampling, resolving issues with accessibility and privacy related barriers. However, there is limited understanding of the acceptability of self-sampling among women in low-income settings. We aimed to assess women's perceptions, experiences, and acceptability of self-sampling for HPV testing for primary cervical cancer screening. We conducted a qualitative phenomenological study among ten purposively sampled women screening for cervical cancer at a rural hospital in Malawi. Data collection instruments and the thematic analytical approach were guided by the Theoretical Framework of Acceptability. Key constructs that were central to this analysis included affective attitude, burden, self-efficacy, intervention coherence, and perceived effectiveness. Self-sampling emerged as a culturally and socially acceptable diagnostic practice by the women, mediated by emic values of privacy, bodily autonomy, and convenience. Women valued the ability to autonomously collect samples, which allowed them to circumvent discomfort and perceived invasiveness linked to speculum use, especially by male clinicians. Sociocultural barriers such as limited literacy levels, poor access to transport, and a lack of spousal approval restricted broader acceptability. Facilitators of acceptability included comprehension of the intervention, confidence in the self-sampling process, and the potential of the intervention to increase screening uptake, reduce cervical cancer screening-related stigma and reduce healthcare worker burden. Self-sampling for cervical cancer screening is an acceptable and promising alternative for improving the uptake of screening among women in Malawi and similar low-income countries. Scale-up of this approach will require addressing socio-cultural barriers through optimising instructional materials, engaging male partners, and leveraging community health workers for scaled community implementation via task-sharing.

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马拉维Thyolo妇女原发性宫颈癌筛查高危HPV DNA检测的可接受性:一项定性研究。
尽管在常规保健设施内推出了宫颈癌筛查,但由于隐私问题、耻辱和距离保健设施很远等因素,马拉维接受宫颈癌筛查的人数仍然很低。人乳头瘤病毒(HPV)检测的自采样提供了一种可行的替代方案,解决了可访问性和与隐私相关的障碍问题。然而,人们对低收入环境中妇女自我抽样的可接受性了解有限。我们的目的是评估妇女的观念,经验和接受自我抽样HPV检测原发性宫颈癌筛查。我们在马拉维的一家农村医院进行了一项定性现象学研究,对10名有目的的抽样妇女进行了宫颈癌筛查。数据收集工具和专题分析方法以可接受性理论框架为指导。该分析的核心关键构念包括情感态度、负担、自我效能、干预一致性和感知有效性。自我抽样成为女性在文化和社会上可接受的诊断实践,以隐私、身体自主和便利的主流价值观为媒介。女性重视自主采集样本的能力,这使她们能够避免使用窥镜带来的不适和侵入性,尤其是男性临床医生。社会文化障碍,如有限的文化水平,交通不便,缺乏配偶的认可,限制了更广泛的接受性。可接受性的促进因素包括对干预措施的理解、对自我抽样过程的信心,以及干预措施在增加筛查接受度、减少宫颈癌筛查相关污名和减轻医护人员负担方面的潜力。在马拉维和类似的低收入国家,宫颈癌筛查的自我抽样是一种可接受和有希望的替代方法,可以提高妇女对筛查的接受程度。推广这一方法将需要通过优化教学材料、吸引男性伙伴以及利用社区卫生工作者通过任务分担扩大社区实施来解决社会文化障碍。
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