Moroccan and Pakistani women's knowledge and perceptions on cervical cancer screening and HPV self-sampling acceptability in Catalonia, Spain: a mixed-methods study.

backgroundDisparities in cervical cancer (CC) screening participation persist, with lower rates among immigrant women from low-resource countries compared to native European women. Evidence-based strategies to reach under-screened women are thus needed, such as adopting self-sampling for human papillomavirus (HPV) testing. Studies have demonstrated that women are receptive to HPV self-sampling. However, results may not be generalizable to all ethnic groups and settings. This is the first study in Spain assessing HPV self-sampling acceptability among immigrant populations. A mixed-methods study was used to explore knowledge and perceptions of CC screening and attitudes towards HPV self-sampling among Moroccan and Pakistani women in Catalonia.

methodsEight focus group discussions and twenty-two semi-structured interviews were conducted. After a short demonstration of two self-sampling devices, women were invited to try them at home and complete an acceptability survey for each device, including questions assessing screening preferences, perceived self-efficacy, trust in the test results and willingness to use the self-collection method again.

resultsImportant barriers, such as lack of information about CC screening, and misconceptions about HPV risk were identified. Overall, Moroccan and Pakistani women expressed a preference for clinician-based screening over self-sampling. Over half of the participants (56%) accepted to try at least one self-sampling device. However, concerns about collecting the sample correctly and distrust in the test result were raised.

conclusionIncreasing awareness and empowering Moroccan and Pakistani women with culturally appropriate information about the benefits of CC screening is the first step to successfully implement HPV self-sampling. Concerns regarding self-efficacy need also to be addressed before implementing new organised screening programmes using HPV self-sampling in Catalonia, Spain. A peer-based approach using culturally appropriate materials is proposed to best inform, educate, foster confidence, and advocate for the uptake of HPV self-sampling among these two groups of women.