If I Have the Courage…I Prefer to See a Doctor: A Qualitative Exploration of Ethiopian Women’s Hesitancy to Screen for Cervical Cancer Using HPV Self-Sampling

Abstract

PURPOSE In Ethiopia, cervical cancer screening uptake remains low (14%), despite efforts to increase access to preventive services. While Ethiopia’s national screening program currently uses a “screen-and-treat” approach with visual inspection with acetic acid (VIA), human papillomavirus (HPV) self-sampling may be a screening option available in the future, which has been found to be a safe and easy approach for sample collection in many global contexts. Some concerns exist among age-eligible women for HPV self-sampling, therefore understanding the nuanced perceptions towards HPV self-sampling from an Ethiopian perspective is important. This qualitative study explores perceived pros and cons to cervical cancer screening with HPV self-sampling so that this approach can be tailored to the cultural and social context of Ethiopia to increase screening uptake. METHODS In 2022, four focus groups were conducted with 50 Ethiopian women to discuss their perceptions towards cervical cancer and cervical cancer screening methods. Participants were shown educational videos on VIA and HPV self-sampling. They were prompted to compare the two screening modalities and discuss why they liked or disliked each. Audio recordings were translated and transcribed, transcripts were coded with Dedoose software, and content analysis was conducted to identify major themes contributing to hesitancy to screen using HPV self-sampling. RESULTS A lack of awareness, coupled with a lack of confidence in collecting their own specimen, influenced many women to have notable negative views of the HPV self-sampling process. Many women thought the self-sampling would be “difficult,” as it “might hurt sensitive places.” A participant shared: “I might not use the device properly. If I have the courage and the desire, I prefer to see a doctor.” Interestingly, participants often stated that they would be more willing to try HPV self-sampling if they had increased understanding, education, and “awareness” of cervical cancer and the procedure. CONCLUSION To promote cancer screening services in underserved communities such as in Ethiopia, it is imperative to understand the major factors that influence screening. Focus groups revealed reasons that women may be hesitant to screen for cervical cancer using HPV self-sampling. Education and screening interventions should address these concerns and self-described knowledge gaps to empower patients to make informed decisions about screening.