Lorna McWilliams

Acceptability of Self‐Sampling for Cervical Screening in Ethnically Diverse Groups in Northwest England: A Focus Group Study

ABSTRACT Introduction Research indicates disproportionately low cervical screening uptake by diverse ethnic groups in England. If acceptable, self‐sampling might address population‐specific barriers and improve screening uptake. The Alternative CErvical Screening (ACES) Diversity study aimed to explore the prospective acceptability of self‐sampling (urine sampling and self‐swabbing), as an alternative to current cervical screening, among women from diverse ethnic groups. Methods A qualitative study design was employed using focus groups. Forty‐eight women from diverse ethnic groups were recruited via community partners in Northwest England and a cross‐sectional survey. Eight focus groups were conducted (one online and seven in‐person; four with interpreters for Mandarin, Cantonese, Polish and Urdu). Data were transcribed, translated and analysed in English using thematic framework analysis guided by the Theoretical Framework of Acceptability. Results Three themes were identified. ‘Cultural considerations’ explored how aspects of culture and faith influenced perceptions of self‐sampling. ‘Desire for comfort and control’ reflected views of how self‐sampling increases autonomy by maintaining privacy, potentially reducing both pain and tension associated with screening. ‘Confidence in testing’ illustrates beliefs about self‐sampling, around ease of use, practical challenges and accuracy concerns. Conclusions Self‐sampling for cervical screening was considered highly acceptable. If introduced, self‐sampling could increase cervical screening uptake amongst women from diverse ethnic groups. Having a choice in how to interact with the screening programme and continuing to raise awareness of cervical screening were considered important. Future research should explore the concurrent or retrospective acceptability of urine self‐sampling for cervical screening. Patient or Public Contribution Multiple public involvement discussion sessions in Northwest England‐based community centres were arranged with women to explore and build understanding about cervical screening and speak about the ACES Diversity study. A further session was held, with an interpreter, to discuss the focus group topic guide and study design with women and create an opportunity for any feedback. Written feedback was provided for the recruitment poster from seven women (two East Asian, two Central and Eastern European, two African‐Caribbean and one South Asian).

Investigating the acceptability of cervical screening, using conventional clinician-taken cervical samples or urine self-sampling, at 6 weeks postnatal: A cross-sectional questionnaire

Objectives United Kingdom (UK) guidelines recommend delaying cervical screening due during pregnancy to 12 weeks postnatal, despite a lack of supporting evidence. This questionnaire-based study aimed to determine the feasibility of a clinical study of cervical screening and urine self-sampling for human papillomavirus (HPV) at 6 weeks postnatal, as pilot work suggested this would improve uptake, if offered at the routine postnatal check-up. Methods Females who were pregnant/recently pregnant were invited to participate in a web-based questionnaire. Questions assessed acceptability of postnatal cervical screening at 6 weeks postnatal, analysed with chi-square, Fisher's exact and Mann–Whitney tests. Free-text responses were coded using the Theoretical Framework of Acceptability (TFA) to conduct a qualitative content analysis. Results Among the 454 participants, 266 (58.6%) would be more likely to undergo cervical screening if offered at 6 weeks postnatal, and an even higher proportion expressed increased willingness if urine self-sampling were offered ( n  = 338; 74.4%). Two-thirds (308/454; 67.8%) would be willing to be screened at 6 weeks postnatal for a research study and 356/454 (78.4%) if it would be limited only to urine self-sampling. When considering screening modality, over half (245/454; 54%) would prefer urine self-sampling to cervical screening, although a fifth (93/454; 21%) preferred conventional sampling. Free-text responses were provided by 279 participants, and these highlighted that affective attitude and burden TFA constructs underpinned prospective acceptability of having screening at 6 weeks postnatal. Conclusions Offering cervical screening at the 6-week postnatal check-up has potential to increase cervical screening participation. Most participants would be interested in taking part in the research. The feasibility of screening at 6 weeks postnatal and concurrent acceptability should be tested in pilot clinical studies.

Investigating the Acceptability of Cervical Screening and Self‐Sampling in Postnatal Women at the 6‐Week Postnatal Check‐Up: A Qualitative Study

ABSTRACT Introduction There is a lack of evidence to support UK and international clinical recommendations to delay cervical screening to 12‐weeks postnatal. In previous studies, half of women were out of date for screening by the end of pregnancy and the majority would be more likely to take up cervical screening, if offered at the 6‐week postnatal check‐up. We explored views about postnatal cervical screening the acceptability of offering cervical screening, using conventional and urine self‐sampling, earlier within the postnatal period. Methods A cross‐sectional qualitative design was used with recruitment from a larger questionnaire‐based study. Twenty‐six online semi‐structured interviews were conducted with 26 pregnant or recently pregnant participants. Interviews were transcribed and pseudonymised. A topic guide was developed, and data analysed using inductive reflexive thematic analysis. Results Three themes were generated from qualitative analysis of verbatim interview transcripts: 1) A window of opportunity; 2) Am I ready yet? Postpartum recovery; and 3) Neglect of women's health in and around pregnancy. Overall, there was a perception that women's health was not a priority in the postnatal period compared with their babies. Conclusion This is the first study to use qualitative interview methods to explore women's views about the offer of cervical screening alongside the postnatal check‐up. Results support the feasibility of a clinical trial to test the accuracy and effect on uptake of offering cervical screening at the postnatal check‐up, although recognised it might be too soon for some. This should be considered in future feasibility research that includes assessment of concurrent acceptability. Patient or Public Contribution This study was performed following focus groups in a quality improvement project, designed to increase uptake of cervical screening in women and people who were pregnant or recently pregnant. The suggestion for combining cervical screening with the routine 6‐week postnatal follow up was an idea generated by new parents and GP practice staff. The Somerset Maternity Voices group provided feedback on study materials, including the consent form and posters. The semi‐structured interview topic guide was designed following free‐text comments in the pre‐PINCS web‐based survey, results of which are published separately. Female pregnant and recently pregnant people, regardless of current gender identity, were included in this study. In line with the Royal College of Obstetricians and Gynaecologists language guide, we will use ‘women’ to describe participants. Clinical Trial Registration Trial was registered with the National Institute for Health and Care Research Central Portfolio Management System (CPMS ID: 55489) and https://bepartofresearch.nihr.ac.uk/ .