Claire Bavor

How would Australian women and people with a cervix like to access self-collection for cervical screening? Screening preferences from a national survey

Abstract Purpose In Australia, cervical screening is usually offered face-to-face through primary care. As self-collection offers flexibility in how and where screening can be accessed, we assessed participant preferences for flexible screening models. Methods We recruited women and people with a cervix aged 24–74 years into a national survey (December 2023–April 2024) via a paid Meta campaign and community networks. Sociodemographic factors associated with a preference for appointment- or non-appointment-based models were assessed using logistic regression, stratified by age, < 50 and ≥ 50 years. Results Among 9,586 respondents, the median age was 41 years, 67.9% lived in a major city, 82.5% were born in Australia, and 62.6% screened regularly. Most (82.6%) viewed flexible options for accessing screening as very important/important. Respondents favored non-appointment-based compared to appointment-based models, with 53.5% of those < 50 ( n  = 4,842) and 49.5% of those ≥ 50 ( n  = 1,257) preferring to receive a swab in the mail when due. Non-appointment-based models were preferred by participants aged < 50 and ≥ 50 years who were never-screened (adjOR = 1.52, 95% CI = 1.18–1.96, p  = 0.001; adjOR = 2.91, 95% CI = 1.67–5.09, p  < 0.001), irregular screeners (adjOR = 1.58, 95% CI = 1.36–1.85, p  < 0.001; adjOR = 1.52, 95% CI = 1.17–1.98, p  = 0.002) and recently eligible for screening (adjOR = 1.64, 95% CI = 1.08–2.50, p  = 0.02) compared to regular screeners. Convenience was the most common reason for participants’ preferred screening model (87.4% non-appointment-based; 55.1% appointment-based). Conclusion Flexibility in how cervical screening can be accessed appeals to many screen-eligible people. Further research trialing different models assessing screening uptake and clinical pathways to follow-up care is needed.

The role of non-medical providers in increasing access to cervical screening: a scoping review

Introduction Involving non-medical providers (NMPs) in cervical screening interventions could be a promising strategy to increase cervical screening participation among never or underscreened populations. We undertook a scoping review of published literature to explore the potential role of NMPs in increasing cervical screening participation. Methods We searched three databases (MEDLINE, EMBASE and CINAHL) to identify relevant scientific research articles published between 2016 and 2024 and extracted data using a standardised extraction tool. Results Our review identified 35 studies (randomised controlled trials (RCTs): n=12, non-RCTs: n=23) from a breadth of geographical and country-level income settings including Australia and New Zealand (n=3), Africa (n=7), Asia (n=4), Europe (n=3) and North (n=15) and South (n=3) America. NMPs in the included studies were community health workers, nurses and midwives; and their key roles involved identifying and recruiting target populations, delivering health education and raising awareness of cervical screening, facilitating self-sampling and providing navigation and follow-up assistance. Most studies included screening participants aged ≥30 years, who were underscreened, not pregnant, from ethnic minority populations, and living in rural or remote communities. NMP-facilitated cervical screening interventions were largely feasible and acceptable among target populations. Compared with the standard of care, which did not involve NMPs, NMP-facilitated interventions generally demonstrated an increased uptake of cervical screening in RCTs (n=11 out of 12) with relative increases ranging from 1.11 to 42.73. In four RCTs, where NMPs facilitated self-sampling, cervical screening uptake rates ranged from 32.0% to 81.0%. Most non-RCTs (n=18) involved NMPs in facilitating self-sampling, with screening uptake rates ranging from 9.0% to 100.0%. Key strategies identified were capacity-building of NMPs through training, and employing outreach strategies to reach underscreened women. Conclusion NMPs could play a wider and an important role in cervical screening, particularly in the context of self-sampling and have the potential to increase access and equity in cervical screening.

‘I Don't Think There Is a One‐Size‐Fits‐All’: A Qualitative Study Exploring Healthcare Professional and Service Provider Perspectives of Using Innovative Models of Cervical Screening to Improve Equitable Access to Self‐Collection

ABSTRACTIntroductionIn the Australian National Cervical Screening Program (NCSP), self‐collection can be performed in any setting deemed appropriate by the healthcare professional who orders the test, creating opportunities to develop innovative cervical screening models that can address known barriers to access for under‐ and never‐screened women and people with a cervix. This study explored the acceptability and appropriateness of innovative models and key considerations for their design and implementation from the perspectives of clinical and non‐clinical providers.MethodsWe conducted online, semi‐structured interviews with healthcare professionals, pathology providers and community service providers (June–October 2023). Data were analyzed using template analysis, a form of thematic analysis.ResultsThere were 132 participants from across Australia (82 clinical providers [e.g., doctors, nurses, midwives]; 34 non‐clinical providers [e.g., health/community service staff, disability support workers, bicultural workers]; and 16 pathology sector professionals). Four overarching themes were identified: acceptability, appropriateness, screening quality and safety, and implementation considerations. Most found innovative models acceptable when appropriately tailored to the needs of different population groups, particularly through community outreach, home in‐reach and peer‐supported services. Embedding clinical governance and oversight in the cervical screening pathway was a high priority to ensure that screening participants received adequate information about cervical screening and appropriate follow‐up care. Participants identified the need for clearly defined roles in the cervical screening pathway, sustainable funding and professional development opportunities to expand the role of nurses and optimize the roles of non‐clinical providers.ConclusionsInnovative models of cervical screening using self‐collection can offer more accessible, inclusive, and convenient care, especially for under‐ and never‐screened populations. Clinical governance and oversight must be embedded in the cervical screening pathway to maintain high‐quality screening services and to support the implementation of tailored and targeted innovative screening models.

Experiences of HPV self-collection among Aboriginal and Torres Strait Islander women and people with a cervix

Since July 2022, Australian guidelines have recommended that anyone eligible for cervical screening be offered a choice between using a self-collected vaginal sample or a clinician-collected cervical sample for Human Papillomavirus (HPV) testing. This study explored cervical screening among 555 Aboriginal and Torres Strait Islander women and people with a cervix, 261 who had screened since the policy change (‘recently screened’). Participants were recruited for an online survey between December-2023 and April-2024. Over half of recently screened participants were offered a choice of collection methods (n = 151, 58%). Of those offered the choice, 67% chose to screen using self-collection (n = 101). In total, 46% (n = 118) of recently screened participants used self-collection, either themselves at home (n = 41, 35%) or the clinic (n = 48, 41%) or assisted by a healthcare provider without a speculum (n = 29, 24%). Among those who collected their own sample (n = 89), the main reasons were it was less embarrassing, they felt in control of their body, and it was less scary. However, only 55% of these participants felt they had enough information to make an informed decision between collection methods. Over half of recently screened participants reported having a clinician-collected sample with a speculum (n = 133, 51%). The majority were not offered a choice of collection method (61%, n = 81), however 38% (n = 50) were and chose a clinician-collected sample. The main reasons for choosing a clinician-collected sample included always having had it done by a healthcare provider, wanting the healthcare provider to have a look or believing the healthcare provider would collect a better sample. This study highlights a preference for HPV self-collection among Aboriginal and Torres Strait Islander women and people with a cervix, including those who already participate in cervical screening. It reinforces the importance of offering all eligible participants a choice of collection methods and supporting informed decision-making.