Research

South African women’s perspectives on self-sampling for cervical cancer screening: A mixed-methods study

R Saidu, J Moodley, A Tergas, M Momberg, R Boa, T Wright, S Campbell, C Svanholm-Barrie, D Persing, L Kuhn, L Denny

Abstract


Background. Self-sampling as a method of screening for cervical cancer and its precursors is an attractive option for low-resource settings. However, to allow successful integration of self-sampling into national screening programmes, it is necessary to understand women’s perceptions and beliefs surrounding this method of sampling the cervix.

Objectives. To explore women’s attitudes to self-collection of samples for cervical screening in a low-resource setting in South Africa (SA).

Methods. Mixed methods were used to meet the study objectives. We recruited women aged 30 - 65 years into a study in Cape Town, SA, to participate in a cross-sectional survey. All women collected a vaginal self-sample, and underwent visual inspection with acetic acid, colposcopy, and collection of cervical samples and appropriate histology specimens by a doctor. Women had a quantitative questionnaire-based exit interview. A subset of these women participated in focus group discussions (FGDs).

Results. A total of 822 women answered the exit survey questionnaire and 41 women participated in the FGDs. Most women from the survey had a positive perception of self-sampling, with 93.6% of the women reporting not feeling embarrassed and 89.4% reporting experiencing no discomfort at all when taking a self-sample. This was corroborated by the FGD participants, who found self-sampling easier, more comfortable and less embarrassing than clinician sampling. However, many women (64.7%) felt more confident when the sample was taken by a clinician, despite having a positive attitude towards self-sampling. In most cases this was because they thought that the clinician would take a better sample, as explained by the FGD participants. Although 93.9% of the women were willing to collect a self-sample, the women in the FGDs expressed a preference for doing so at the health facility rather than at home. There were many reasons for this, including the cost of returning to the clinic with the sample.

Conclusions. Attitudes regarding self-sample collection were positive in this study population. Participants were willing to perform self-sampling, but expressed concerns regarding the quality of the specimen and the financial implications of returning to the clinic with it. Pilot implementation studies will be useful before this method of sampling is adopted and integrated into screening programmes.

 


Authors' affiliations

R Saidu, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa; SAMRC Gynaecological Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin, Nigeria

J Moodley, SAMRC Gynaecological Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, South Africa; Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, South Africa; Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

A Tergas, New York Center for Lower Genital Tract Disease, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, USA

M Momberg, Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

R Boa, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa

T Wright, Professor Emeritus of Pathology and Cell Biology, Columbia University, New York, USA

S Campbell, Cepheid Inc., Sunnyvale, Calif., USA

C Svanholm-Barrie, Cepheid Inc., Stockholm, Sweden

D Persing, Cepheid Inc., Sunnyvale, Calif., USA

L Kuhn, Gertrude H Sergievsky Center, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, USA

L Denny, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa; SAMRC Gynaecological Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, South Africa

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Keywords

Self-sampling; HPV typing; Cervical; Cancer; Screening

Cite this article

South African Medical Journal 2019;109(1):47-52. DOI:10.7196/SAMJ.2018.v109i1.13278

Article History

Date submitted: 2018-12-13
Date published: 2018-12-13

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