Promoting cervical cancer screening via a mailed HPV self-collection kit: Reactions from screeners and non-screeners

IF 3.1 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling Pub Date : 2025-10-03 DOI:10.1016/j.pec.2025.109374

Jasmin A. Tiro , Sadie Metcalfe , Meera Muthukrishnan , Angelina Jose , Kris Hansen , John Lin , Caitlin N. Dorsey , Hongyuan Gao , Catherine Lacey , Melissa L. Anderson , Richard T. Meenan , Beverly B. Green , Diana S.M. Buist , Angela Sparks , Rachel L. Winer

{"title":"Promoting cervical cancer screening via a mailed HPV self-collection kit: Reactions from screeners and non-screeners","authors":"Jasmin A. Tiro , Sadie Metcalfe , Meera Muthukrishnan , Angelina Jose , Kris Hansen , John Lin , Caitlin N. Dorsey , Hongyuan Gao , Catherine Lacey , Melissa L. Anderson , Richard T. Meenan , Beverly B. Green , Diana S.M. Buist , Angela Sparks , Rachel L. Winer","doi":"10.1016/j.pec.2025.109374","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Mailed human papillomavirus self-collection (HPV-SC) kits improve cervical cancer screening adherence; however, not all respond to kit invitations. This qualitative study sought to understand reactions to HPV-SC kit invitation among screeners and non-screeners in the STEP trial, a pragmatic trial offering kits.</div></div><div><h3>Methods</h3><div>Kaiser Permanente Washington patients randomized to the STEP trial’s kit intervention arms, received educational materials and were notified they would receive a kit in one week (direct mail) or given information on how to request a kit (opt-in). Materials highlighted cancer risk, screening importance, test differences (Pap, HPV), and what to expect with abnormal results. Based on their screening status 6 months post-randomization, two categories of patients were invited for focus groups: 1) screeners with negative kit results or clinician-performed test; 2) non-screeners. We oversampled non-white patients. Six online focus groups were conducted from May to June 2022 with 40 patients (29 screeners, 11 non-screeners). A facilitator asked about HPV and cervical cancer knowledge, reaction to the kit and educational materials, and screening preference (self- vs. clinician-collected). Field notes and transcripts were analyzed by five coders using iterative content analysis.</div></div><div><h3>Results</h3><div>Participants desired more flexibility during the invitation process, preferring multiple methods (mail, patient portal, text, in-clinic distribution) and support services (website, nurse-staffed phone). Educational resources acknowledging different learning styles (print, diagrams, audio-visual) and for specific populations (LGBTQ, monogamous) were suggested. Participants recommended clinicians reinforce kit efficacy to encourage use. Trust in the kit and in the health care system were key to ensure comfort with self-collection.</div></div><div><h3>Conclusion</h3><div>Multiple, diverse outreach strategies are needed to engage patients in screening with this new modality.</div></div><div><h3>Practice implications</h3><div>Flexible engagement by the healthcare system with comprehensive educational materials inclusive of diverse populations, and provider encouragement are needed to build patients’ trust in, comfort with, and use of HPV-SC tests.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov Identifier: NCT04679675</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"142 ","pages":"Article 109374"},"PeriodicalIF":3.1000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Patient Education and Counseling","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0738399125007414","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Mailed human papillomavirus self-collection (HPV-SC) kits improve cervical cancer screening adherence; however, not all respond to kit invitations. This qualitative study sought to understand reactions to HPV-SC kit invitation among screeners and non-screeners in the STEP trial, a pragmatic trial offering kits.

Methods

Kaiser Permanente Washington patients randomized to the STEP trial’s kit intervention arms, received educational materials and were notified they would receive a kit in one week (direct mail) or given information on how to request a kit (opt-in). Materials highlighted cancer risk, screening importance, test differences (Pap, HPV), and what to expect with abnormal results. Based on their screening status 6 months post-randomization, two categories of patients were invited for focus groups: 1) screeners with negative kit results or clinician-performed test; 2) non-screeners. We oversampled non-white patients. Six online focus groups were conducted from May to June 2022 with 40 patients (29 screeners, 11 non-screeners). A facilitator asked about HPV and cervical cancer knowledge, reaction to the kit and educational materials, and screening preference (self- vs. clinician-collected). Field notes and transcripts were analyzed by five coders using iterative content analysis.

Results

Participants desired more flexibility during the invitation process, preferring multiple methods (mail, patient portal, text, in-clinic distribution) and support services (website, nurse-staffed phone). Educational resources acknowledging different learning styles (print, diagrams, audio-visual) and for specific populations (LGBTQ, monogamous) were suggested. Participants recommended clinicians reinforce kit efficacy to encourage use. Trust in the kit and in the health care system were key to ensure comfort with self-collection.

Conclusion

Multiple, diverse outreach strategies are needed to engage patients in screening with this new modality.

Practice implications

Flexible engagement by the healthcare system with comprehensive educational materials inclusive of diverse populations, and provider encouragement are needed to build patients’ trust in, comfort with, and use of HPV-SC tests.

Trial registration

ClinicalTrials.gov Identifier: NCT04679675

查看原文本刊更多论文

透过邮寄的人乳头瘤病毒自我收集工具推广子宫颈癌筛查：筛查者和非筛查者的反应。

目的：邮寄人乳头瘤病毒自收集（HPV-SC）试剂盒提高宫颈癌筛查依从性；然而，并不是所有人都对工具包邀请做出回应。这项定性研究旨在了解STEP试验中筛查者和非筛查者对HPV-SC试剂盒邀请的反应，这是一项提供试剂盒的实用试验。方法：Kaiser Permanente Washington的患者被随机分配到STEP试验的试剂盒干预组，接受教育材料，并被告知他们将在一周内收到一个试剂盒（直接邮寄）或提供如何申请试剂盒的信息（选择加入）。材料强调了癌症风险，筛查的重要性，检测差异（Pap， HPV），以及异常结果的预期。根据随机分组后6个月的筛查状况，邀请两类患者参加焦点小组：1)试剂盒结果阴性或临床检查阴性的筛查者；2) non-screeners。我们对非白人患者进行了抽样调查。从2022年5月至6月，对40名患者进行了6次在线焦点小组调查（29名筛查者，11名非筛查者）。主持人询问了HPV和宫颈癌的知识，对试剂盒和教育材料的反应，以及筛查偏好（自我与临床收集）。现场记录和抄本由五名编码员使用迭代内容分析进行分析。结果：参与者希望在邀请过程中有更大的灵活性，更喜欢多种方式（邮件、患者门户、短信、诊所分发）和支持服务（网站、护士电话）。建议提供承认不同学习方式（印刷品、图表、视听）和特定人群（LGBTQ、一夫一妻制）的教育资源。参与者建议临床医生加强试剂盒的功效以鼓励使用。对试剂盒和卫生保健系统的信任是确保自我收集舒适的关键。结论：需要多种多样的外展策略来吸引患者参与这种新模式的筛查。实践意义：需要医疗保健系统灵活地参与包括不同人群的综合教育材料，以及提供者的鼓励，以建立患者对HPV-SC测试的信任，舒适和使用。试验注册：ClinicalTrials.gov标识符：NCT04679675。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Patient Education and Counseling 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.60

自引率

11.40%

发文量

384

审稿时长

46 days

期刊介绍： Patient Education and Counseling is an interdisciplinary, international journal for patient education and health promotion researchers, managers and clinicians. The journal seeks to explore and elucidate the educational, counseling and communication models in health care. Its aim is to provide a forum for fundamental as well as applied research, and to promote the study of organizational issues involved with the delivery of patient education, counseling, health promotion services and training models in improving communication between providers and patients.