Experiences and Perceptions of Cervical Cancer Screening Using Self-Sampling among Under-Screened Women in Flanders
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Population and Recruitment
2.3. Procedure and Data Collection
2.4. Data Analysis
3. Results
3.1. Attitude
- P4: “I think, the faster you can detect it, the less damage it can do, so it’s a win-win situation for yourself and for the healthcare system in general. So I think it is very important.”
- P8: “I am a supporter of it (cancer screening). Like I said, that’s how they were able to diagnose my mother-in-law with colon cancer.”
- P11: “Yes, I would even prefer it, to take a self-sample, because it’s something very intimate. I don’t like to have it done by a gynecologist.”
- P4: “I don’t believe in all vaccines, but I do believe in this one.”
- P6: “My daughter has been vaccinated, maybe even 15 years ago, which was even before the vaccination was reimbursed by health insurance, but I thought it was important to do it.”
- P2: “I also believe that my daughter, who will be 12 in March, that her first vaccination will happen soon, because it’s a couple of times (that they have to get the vaccination) I think, no?”
- P5: “I know that they use it for young people now but in my time, it wasn’t. But I think it starts at about 16 yo. But when I was young that wasn’t the case yet. I don’t know if that’s still useful now. It could be but if you’re past a certain age, I don’t know…”
- P8: “I have a little son so it’s not applicable to him.”
- P9: “I thought they suggested it pretty early, as early as 12–15 yo? I mean, the vaccine, not the screening?”
3.2. Subjective Norms
- P6: “It is mentioned by the gynecologist on a regular basis. Actually, my family physician who has my medical file has also told me several times that it is time to do it (the PAP smear).”
- P3: “My wife works in a vaccination center, so it would be weird to be an anti-vaxxer. I also remember that before boys were vaccinated (for HPV), she told me she wanted our boys to be vaccinated and she knows a lot more about it so I thought ‘it’s OK’. I also think that it doesn’t do any harm, so I think that every chance to reduce the risk of cancer is good.”
- P8: “The reason why I participate is because two years ago I lost a cousin because of it (cervical cancer) and I also have a friend who is infertile because of it. So I know it can have far-reaching consequences.”
- P4: “And then (after receiving an invitation letter) we (participant and her wife) thought it’s been a long time indeed, we need to make an appointment for it, this year we are definitely going to do it (smiling).”
- P11: “Is it every three years that you get an invitation?” (interviewer: ‘Normally, yes’)
- P11: “So that’s a reminder, that’s a good thing. It is necessary.”
3.3. Perceived Behavioral Control
3.4. Facilitators
- P2: “I think it is a good thing that it is for free and that that is clearly stated. I think for a lot of people and for certain communities this is really important.”
- P11: “And the cervix, is that…. Is that here, is that this cancer? We talk about cervical cancer, but where is that (the cancer)? And then where is the cervix located? Because I also have a uterus, I have two children, but I don’t know… Because YOU (the interviewers) have studied it, YOU know this. But WE don’t. I had absolutely no idea. At first I thought, yes, those are the ovaries, I know that. But then what is this cervical cancer? Is that here or there? In our target group, we always try to work with powerpoints, that they have the information and that they understand it. They’re at a certain age and most of them haven’t even been to school. So you have to try to explain it really low-key.”
- P15: “I thought it was good to read about the different steps and it is also reassuring, I mean it encourages regular testing because it literally says ‘when you detect early, it’s not such a big problem.’ I think this information in the flyer is really reassuring.”
3.4.1. Facilitators for Participation in the Current Cervical Cancer Screening Program
- P3: “After giving birth, I didn’t mind that much as before because maybe there was more space…”
- P5: “If I’m honest, I did it once in my life, that was before I decided to have children, at that moment it suddenly seemed important and before it didn’t.”
- P7: “I think if I ever have children and then go to a gynecologist, it’s easier because you’re in contact with someone and you know him/her, but for now to go search for someone that I don’t know…”
3.4.2. Facilitators for Screening Using Self-Sampling Methods
- P6: “I think it’s really comfortable (self-sampling) because I don’t like waiting or moving around. Maybe it’s weird but for me it’s a big obstacle to go outside of the house.”
- P8: “I think the barrier is lower because you don’t have to go to the physician and you don’t have to make an appointment. It can also be an advantage if you feel ashamed to go to the physician for a PAP smear that you can do it yourself.”
- P15: “For me it’s a good solution because you can do it whenever you want, when you are relaxed. Because otherwise you may be a bit stressed and your body is going to react differently. I would also find it more convenient that I don’t have to go to the physician, and don’t have to make an appointment… I’m not embarrassed about it but I would find it easier that I don’t have to make an appointment because the physician is always busy and I would have to bother him for a PAP smear. However, if something is wrong, I would go, but just for the screening I think it would be OK to do it myself.”
- P4: “I am very curious about the vaginal swab because I think it would solve everything. Because it’s not difficult to do, you can do it at home and then send it or bring it somewhere, it would be really easy.”
- P11: “A physician is specialized and has studied for it. He is probably better at other types of examinations such as examining the breasts and things like that. But a PAP smear, you can do it equally well yourself.”
- P2: “I think this (urine sample) is the easiest method and for a lot of women also the least invasive. It’s the same as bringing a urine sample to your physician and a stand to pee prosthetic device is very useful of course.”
- P11: “It’s the same as a COVID swab, you can do it all by yourself.”
3.5. Barriers
3.5.1. Barriers to Participating in the Current Organized Cervical Cancer Screening Program
- P1: “It would be good if you have to make the appointment during working hours, you would get paid time off. Because I have two children and I need all my vacation days for their vacation. When you go to the family physician, you can do it in the evening but with the gynecologist it’s not possible. So it would help if it’s possible (to make an appointment) outside the working hours or that you can get paid time off for it.”
- P6: “My gynecologist retired so now I no longer have regular contact anymore. You still have your family physician who knows you, but they know you too well to have your PAP smear taken by them.”
- P7: “Because the waiting times for appointments are so long, you tell yourself ‘I will do it some other time’ and then you never do it anymore.”
- P13: “But I don’t seem to have received the invitation, or I might have thought ‘I’ll do it later’ and put it aside and then forgot about it. It must have happened like that, as it does with a lot of people I guess.”
- P2: “Many people carry it, that’s what I think it was anyway. They do carry the gene, but it doesn’t manifest in everyone, I would say.”
- P3: “I know it (cervical cancer) is some kind of STI, which is why, because I’m with a woman, my chances are smaller and therefore it’s easier to say ‘meh’. I know men are mainly the carriers, so my risk is smaller but still exists.”
- P5: “If you know at which age the condition occurs, and you are around this age, you are going to take part in the screening more easily.”
- P6: “I would say I link it to penetration but that may be completely wrong.”
- P1: “Is the screening program not specifically targeted? That’s just for all women?”
- P5: “I didn’t know you could do that with your family physician, but maybe it’s easier because he’s more of a confidant you see more often than your gynecologist.”
- P6: “I go to the family physician annually anyway and I think actually a smear test is basically suggested annually, isn’t it?”
- P6: “No, I think (the screening starts) probably from when you have your period maybe, but could be just as good after pregnancy, I really don’t know.”
- P8: “I used to do it every year, but because of the COVID pandemic, I lost sight of it.”
- P11: “I can reassure myself, like, there is nothing wrong if I don’t feel bad, so I don’t have to go and do it (PAP smear)”
- P2: “I had a daughter 12 years ago, but my delivery was very difficult. I got induced because I was at risk for preeclampsia because of high blood pressure and they eventually had to insert 36 tablets and then I said ‘now it’s enough, there is only gonna come something out of my vagina, but nothing gets in anymore’. I have booked appointments afterwards, but was always so nervous that I couldn’t go anymore.”
- P7: “I would consider it and see when I could book an appointment. But if the appointment would then be scheduled after six months, my fear would take the upper hand and I probably wouldn’t do it anymore.”
- P9: “I had breast cancer, and in the beginning, you get all these therapies and then after a while it’s only hormonal therapy, and then after that only six-month checkups and then yearly and then every two years. In time, it gets less prominent and you feel more secure, and I link the two (cervical and breast cancer), even though I know they are not actually connected.”
3.5.2. Barriers for the Use of Self-Sampling Methods
- P1: “It’s a lot of information, however I am used to reading a lot. I don’t know if that’s the case for everyone, but for me it was clear.”
- P2: “I find it too much to remember to be able to do it in one smooth motion.”
- P4: “For the classic Flemish inhabitant it will be ok, but for non-native immigrants or people who have difficulties reading, it’s going to be too much. But maybe they don’t go to the gynecologist or family physician either, so you will probably still not reach a part of the population.”
- P5: “Yes, it’s caused by a virus…. Couldn’t it be that maybe you’re already infected, but it just hasn’t come to expression yet? Or is it only because of certain triggers that you develop cancer?”
- P8: “I know that it can be detected in the lining of the uterus.”
- P9: “Hmm I know it makes a difference whether it’s HPV positive or negative but the exact link, I can’t really answer that.”
- P15: “They did say on the phone once briefly something like ‘we’ve seen something,’ I don’t know how they described that, but ‘we’ve seen something that raises a question mark’ or I don’t know how they said that, ‘so we’ll have to do that again after a few weeks’, but actually I never really knew what it was then …”
- P5: “I think maybe with a gynecologist it will always be better. I would think that I don’t do it well, although with a urine sample you can’t do that much wrong, it has to be first void but other than that…”
- P8: “Some people might not be so handy with this. For me, I am not young, but not old either, so for me it went quite smoothly.”
- P15: “I might want to do it, but I would worry that I wouldn’t do it correctly, like with the COVID self-tests, when you didn’t put it deep enough. So I would think ‘did I do it right?’. You always trust someone else who does it for you a bit more.”
3.6. Intention
3.7. Behavior
3.8. Experiences after Self-Sampling
- P1: “My hands weren’t dirty at all, it turned out much better than I expected. Like it said here, you don’t have to worry, I thought it (the urine sample) was going to overflow… But it is well designed so that the tube isn’t totally full.”
- P15: “Because I once did it at the family physician, for me this (the vaginal swab) felt the same. I thought maybe I won’t feel anything, but I did feel that something happened. This gave me a reassuring feeling that it would be good.”
- P1: “The only thing was that with the vaginal swab, when you have to pull to get the white brush back inside, you have to pull really hard and that didn’t work immediately with me.”
- P3: “The peeing is a bit messy, you pee a bit on the tube and, when you get up too fast, also on the toilet seat. When it’s at home, it’s no problem but here (the public restroom) you think about the person that comes after you.”
- P4: “This just comes to your house, it’s not invasive, you can do it whenever you want, it would definitely help. I would definitely participate.”
- P7: “Once you have started and you go step by step, it was very clear and easy to use. If they would send me this every year, no problem, I would do it every year.”
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Age | N |
30–39 yo | 6 |
40–49 yo | 3 |
50–59 yo | 3 |
60–62 yo | 2 |
Not known | 1 |
Educational level | N |
Secondary education | 1 |
Post-secondary education | 14 |
Has a regular family physician | N |
Yes | 13 |
No | 1 |
Unknown | 1 |
Has already consulted a gynecologist | N |
Yes | 14 |
No | 1 |
Is aware of the organized cervical cancer screening program | N |
Yes | 13 |
No | 2 |
Knows you can have a PAP smear taken with the family physician | N |
Yes | 11 |
No | 4 |
Previous experience with PAP smears | N |
Yes | 14 |
No | 1 |
Vaccination status for HPV | N |
Vaccinated | 3 |
Not vaccinated | 9 |
Unknown | 3 |
Migration background | N |
Yes | 4 |
No | 11 |
Mentioned Barriers for Screening in the Current Organized Cervical Cancer Screening | Mentioned Barriers for Screening by Using Self-Sampling Methods | |
---|---|---|
Organization |
| |
Information |
|
|
Context |
| |
Emotions |
|
|
Low self-efficacy |
|
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Share and Cite
Buelens, C.; Stabel, M.; Wildiers, A.; Peremans, L.; Van Hal, G.; Van Doorsselaere, L.; Lievens, A.; Vorsters, A.; Van Keer, S.; Verhoeven, V. Experiences and Perceptions of Cervical Cancer Screening Using Self-Sampling among Under-Screened Women in Flanders. Healthcare 2024, 12, 1704. https://doi.org/10.3390/healthcare12171704
Buelens C, Stabel M, Wildiers A, Peremans L, Van Hal G, Van Doorsselaere L, Lievens A, Vorsters A, Van Keer S, Verhoeven V. Experiences and Perceptions of Cervical Cancer Screening Using Self-Sampling among Under-Screened Women in Flanders. Healthcare. 2024; 12(17):1704. https://doi.org/10.3390/healthcare12171704
Chicago/Turabian StyleBuelens, Charlotte, Margot Stabel, Alice Wildiers, Lieve Peremans, Guido Van Hal, Lotje Van Doorsselaere, Annouk Lievens, Alex Vorsters, Severien Van Keer, and Veronique Verhoeven. 2024. "Experiences and Perceptions of Cervical Cancer Screening Using Self-Sampling among Under-Screened Women in Flanders" Healthcare 12, no. 17: 1704. https://doi.org/10.3390/healthcare12171704