Motivation, capacity and opportunities for cervical cancer home-based vaginal self-sampling in Réunion Island: a qualitative study.

backgroundCervical cancer remains a major public health concern. In France, women in deprived areas face a 62% higher risk, yet nearly 40% of eligible women are under-screened. While HPV self-sampling can double or triple screening rates, these rarely exceed 30%. Prior studies have overlooked women experiencing both insufficient screening and socioeconomic disadvantage. The RESISTE trial addressed these gaps using combined quantitative and qualitative methods. In this work, we evaluated behavioural strategies targeting both women's capacity to perform self-sampling and their perception of screening opportunities, in Réunion Island.

method35 semi-structured interviews were conducted among women who had received a RESISTE self-sampling kit: 16 were respondents who had returned the kit and 13 were non-respondents. These participants came from across the island and were of varying age groups. We also interviewed health professionals who had been contacted by women during the trial (6). Following an inductive thematic analysis, the Behaviour Change Wheel was used to identify factors relating to capability, motivation and external opportunities.

resultsAfter receiving the kit, several women underwent screening either by self-sampling or by visiting a health professional. Ease of use, convenience and privacy were key factors in self-sampling uptake. Receiving the kit at home creates a sense of being targeted which reinforces the perceived relevance of screening. Relatives generally had a facilitating effect, encouraging self-sampling and follow-up. An HPV positive result was a strong motivator to undergo a follow-up smear test. Nevertheless, a lack of prior knowledge of vaginal self-sampling led to a lack of trust in the programme amongst women. This and the perceived complexity of the procedure were the main demotivating factors. The financial incentive contributed to doubts regarding authenticity. In addition, the health professionals contacted rarely encouraged women to self-sample.

conclusionsWomen appreciated receiving an HPV vaginal self-sampling kit at home. Their motivation and capability could be improved by increasing prior communication - to both women and health professionals - on self-sampling in general, and more specifically on reliability, sample preservation and ease of use. Future research should be conducted among healthcare professionals, to identify the obstacles to including self-sample screening into their practices.

trial registration6 February 2020 "SudOuest et OutreMer II" ethics committee Version 04 dated 29 July 2023 is currently in force IDRCB no. 2020A0002237 (File 220006 id6698) 2°HPs.