Cervical cancer disproportionately affects women who are low-income and never/underscreened (never screened or under screened) especially in Indiana, where cervical cancer incidence and mortality are higher than the US national average, and screening is lower than the US national average. Women who are low- income have structural and intrapersonal barriers to screening that may prevent them from obtaining provider- based screening. Although HPV testing is now accepted by USPTF guidelines, it is only endorsed for provider- collected sampling. Self-sampling for HPV testing, a method for women to collect their own cervico-vaginal sample, has been established as a feasible and acceptable alternative to provider-based cervical cancer screening in other countries and is supported by US pilot studies. HPV self-sampling is likely to be implemented as a screening option in the US in the future due to its comparable sensitivity to provider- collected HPV samples, acceptability, and potential to reach populations who are never/underscreeners. Self- sampling may overcome barriers to provider-based cervical cancer screening experienced by women who are low-income and never/underscreened and provide a convenient way to access screening. Studies testing mailed HPV kits, however, have demonstrated that 30-50% of women do not return a mailed HPV kit. Prior to widespread implementation, research is needed to identify characteristics of returners and non-returners of mailed HPV self-sampling kits. The purpose of this descriptive study is to identify factors associated with mailed return of HPV self-sampling kits using concepts from the Diffusion of Innovations Theory (advantages, compatibility, complexity, and self-efficacy) while controlling for sociodemographic, healthcare, and health behavior variables in a group of low-income and never/underscreened women. Data for this cross-sectional study will be collected at time of study consent from women (n=200) at a food pantry and nonadherent to cervical cancer screening using valid and reliable instruments. Self-sampling kits will be mailed to the women?s home within one week of consent, and women will have 4 weeks to return the kit to be considered ?returners?. Logistic regression analyses will be used to analyze the relationship between the data collected at baseline consent (attributes of innovation-advantages, compatibility, complexity, and self- efficacy) and return of the self-sampling kit via mail (y/n). The results of this study will provide knowledge about factors associated with return of self-sampling kits to better understand the characteristics of returners and non-returners. Results of this project will help guide implementation of HPV self-sampling in populations who are low-income and never/underscreened whom self- sampling may most likely benefit. This study will provide a foundation for the applicant?s long-term goal of reducing morbidity and mortality from cervical cancer through increasing cervical cancer screening rates with an innovative technology, self-sampling for HPV testing.
Women who are low-income and never/underscreeners are unequally burdened by cervical cancer. This study will be one of the first to identify factors associated with mailed return of a cervical cancer screening tool, self- sampling for HPV self-testing, that will provide an alternative to traditional cervical screening by removing barriers for women most at risk for cervical cancer (women who are low-income and never/underscreeners).
