On the path toward cervical cancer elimination in Canada: a national survey of factors influencing women's intentions to participate in human papillomavirus test-based primary cervical screening.

Background: HPV test-based primary cervical screening is replacing cytology in Canada. In other countries, women's unpreparedness and concerns hindered the transition and post-implementation screening uptake. We investigated psychosocial correlates of intentions of screening in eligible individuals to participate in HPV-based primary cervical screening. Methods: We conducted a nationwide web-based survey of individuals aged 21-70 years in 2022 and oversampled under-screened individuals. We used five Canadian-validated scales to measure HPV test-based screening knowledge, attitudes, and beliefs. Using the multistage Precaution Adoption Process Model, we assessed women's stage of intentions to participate in HPV testing and self-sampling. We estimated associations of psychosocial factors with intentions' stage using multinomial logistic regression. Findings: In both groups (adequately screened n = 1778; under-screened n = 1570), higher HPV knowledge was associated with intention for HPV testing and more personal barriers to the HPV test were associated with lower intentions to participate in HPV testing or use of self-sampling. In both groups, higher self-sampling concerns were associated with lower intentions for self-sampling and higher women's need for autonomy was associated with increased intentions for self-sampling. In the under-screened group, increased age was associated with lower intentions for HPV testing and self-sampling, while living in Canada for <10 years was associated with higher intentions. Interpretation: Our results could be used by policymakers and healthcare professionals to design communication strategies and ensure a smooth transition to HPV-based primary cervical screening, especially for under-screened individuals. Funding: Canadian Institutes of Health Research project grant 165905.