Perceived barriers to cervical cancer screening and motivators for at‐home human papillomavirus self‐ sampling during the COVID‐19 pandemic: Results from a telephone survey

Background. Home‐based self‐sampling for human papillomavirus (HPV) testing may be an alternative for women not attending clinic‐based cervical cancer screening. Methods. We assessed barriers to care and motivators to use at‐home HPV self‐sampling kits during the COVID‐19 pandemic as part of a randomized controlled trial evaluating kit effectiveness. Participants were women aged 30‐65 and under‐screened for cervical cancer in a safety‐net healthcare system. We conducted telephone surveys in English/Spanish among a subgroup of trial participants, assessed differences between groups, and determined statistical significance at p<0.05. Results. Over half of 233 survey participants reported that clinic‐based screening (Pap) is uncomfortable (67.8%), embarrassing (52.4%), and discomfort seeing male providers (63.1%). The last two factors were significantly more prevalent among Spanish versus English speakers (66.4% vs. 30% (p=0.000) and 69.9 vs. 52.2% (p=0.006), respectively). Most women who completed the kit found Pap more embarrassing (69.3%), stressful (55.6%), and less convenient (55.6%) than the kit. The first factor was more prevalent among Spanish versus English speakers (79.6% vs. 53.38%, p=0.001) and among patients with elementary education or below. Conclusions. The COVID‐19 pandemic influenced most (59.5%) to participate in the trial due to fear of COVID, difficulty making appointments, and ease of using kits. HPV self‐sampling kits may reduce barriers among under‐screened women in a safety‐net system.