Nurse Roles Implementing the Choice for Self-Collection Cervical Screening in Rural Settings: A Qualitative Study Following National Policy Change.

Abstract

AIM To explore the key factors influencing nurses' capability, opportunity and motivation to offer the choice for self-collection for cervical screening within rural primary care services, following a national policy change in Australia. DESIGN A qualitative study informed by implementation and behavioural change frameworks. METHODS Primary health nurses working in Victoria were invited to participate in semi-structured interviews via video or telephone between December 2022 and March 2023. Eighteen nurses from 18 clinics participated. Interview data were analysed following a Framework analysis approach, and themes were mapped to the COM-B model. RESULTS Nurses were highly motivated to offer the choice for self-collection due to perceived advantages for their patients and potential opportunities for reaching people hesitant to screen. There was variation in how nurses offered this choice, and to whom. Some nurses were concerned about lost opportunities to visualise the vulval area or cervix, or to have broader health and wellbeing conversations with patients. Views were mixed about how self-collection would impact nurse roles, and several external factors were impacting their opportunities as cervical screening providers. CONCLUSIONS Appropriately trained nurses have the capability and motivation to incorporate the choice for self-collection within their screening practice; however, their opportunity to maximise equity and increase participation is impacted by funding models and structures that limit their autonomy. IMPACT People living outside major cities experience greater healthcare inequities. Australia introduced access to the choice for self-collection for all eligible individuals in 2022, in part to achieve greater equity in the national screening program. Nurses can play a key role in program delivery. Understanding how they incorporate self-collection into their practice, and the key factors influencing implementation in rural primary care settings, can inform future program implementation and improve outcomes for patients. REPORTING METHOD We have adhered to COREQ reporting guidelines. PATIENT OR PUBLIC INVOLVEMENT This study did not include patient or public involvement in its design, conduct or reporting.