Table 2.
Characteristics and comparison of the studies assessing the HPV self-sampling devices’ acceptability.
| Authors/study | Location/population | Study design | Participants (N) | Age (years) | Intervention description |
Acceptance of self-collection | Additional information | Conclusion | |||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Self-sampling tool type | Sample type | Sampling approach | Survey used | ||||||||
| Abuelo et al., 2014 | Peru/urban communities along the Amazon | Not reported | 320 | 30–45 | “Just for Me”self-administered cervicovaginal sampling brush | 1.Vaginal smear | 1. Self-sampling vs. 2.Clinician-taken sample | A questionnaire (self-administered paper questionnaire) | 99.7 % | – | The self-sampling technique may be appropriate for large-scale cervical cancer preventative interventions |
| Andersson et al., 2021 | Sweden/ Stockholm County | Case-control | 43 cases, 479 controls | ≥34 | Female Swab Sample Packet (Cobas) | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 100 % | Acceptance of women from the control group was 74 % | Educating women regarding cervical cancer and HPV testing will improve attendance |
| Aranda Flores et al., 2021 | Mexico/Mexico City | Randomized clinical rtial | 505 | 30–65 | 1.XytoTest medical Device; 2.Cervex-Brush |
1. Vaginal smear; 2. Cervical smear |
1.Self-sampling vs. 2.Clinician-taken sample | A questionnaire (type is not specified) | 96.8 % | 88.8 % reported no discomfort at all performing the procedure | A high acceptance is reported |
| Behnke et al., 2020 | Ghana/ North Tongu district | Mixed-method | 52 | 23–59 | 1.Delphi Screener; 2.Evalyn Brush | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 98.1 % | All responders found self-sampling to be ‘Easy’ or ‘Very Easy’ | Self-sampling for cervical cancer screening is highly acceptable |
| Bishop et al., 2019 | USA/Hispanic,non-Hispanic white, non-Hispanic black | Cross-sectional | 605 | 21–65 | 1.EvalynBrush; 2.HerSwab; 3.Catch-All Swab; 4.Qvintip |
Vaginal smear | Self-sampling | Online survey | 1.67.6 % 2.49.4 % 3.73.9 % 4.72.1 % |
53.1 % of participants concerned about the self-sampling test accuracy | Acceptability of HPV self-sampling as a cervical cancer screening strategy was high |
| Brandt et al., 2019 | Ethiopia/Northwest rural district | Qualitative | 41 | 20–65 | Evalyn Brush | Vaginal smear | Self-sampling | Community-based focus group discussions |
High | High level of misconceptions and low awareness about cervical cancer and screening among respondents | Home-based self-sampling for cervical cancer screening is a socially acceptable and feasible method |
| Cadman et al., 2014 | England and Wales/Indian (Hindu) | Mixed methods | 185 | 25–64 | 1.Dacron swab; 2. Evalyn brush |
Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | Low | Self-collected sampling had a mixed reception | Familiar barriers to screening; Lack of women’s confidence |
| Castell et al., 2014 | Germany/Hamburg and Hanover | Cross-sectional | 162 | 20–69 | Delphi Screener | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 98 % | – | The self-sampling was very well accepted |
| Chan et al., 2023 | Hong Kong | Prospective study | 104 | 30–65 | 1. Cepillo Endocervical/Cervical Brush/Cyto-Brush + DNA sample storage card; 2. Cervex-Brush |
1. Vaginal smear; 2. Cervical smear |
1.Self-sampling vs. 2.Clinician-taken sample | A questionnaire (self-administered) | 65 % | 68 % - not feeling embarrassed; 58 % - convenient |
Self-sampling was shown to be a generally well-accepted method of cervical cancer screening |
| Chatzistamatiou et al., 2017 | Greeece/rural Greek | Cross-sectional | 346 | 25–60 | 1.Evalyn brush | 1. Vaginal smear; | Self-sampling vs. Clinician-taken sample | A questionnaire (self-administered paper questionnaire) | 82.4 % | 92.3 % were positive towards self-sampling | Self-sampling is well-accepted for HPV-based screening |
| Chatzistamatiou et al., 2020 | Greece/rural Greek | Cross-sectional | 13,111 | 25–60 | Self-sampling collection kit (dry cotton swab and sterile vial |
Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 67.9 % | 74.4 % of the women felt adequately confident about self-sampling |
Self-sampling is highly acceptable |
| Crofts et al., 2015 | Cameroon/East Province of | Not reported | 540 | 30–65 | Copan ESwab® | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 95.6 % | Acceptance of self-sampling had no correlation with socio-demographic factors | The self-sampling approach was very well accepted |
| De Pauw et al., 2021 | Belgium/not specified | The VALHUDES framework - Diagnostic test accuracy study following STARD guideline | 515 | 25–64 | 1. Multi-Collect swab; 2. Evalyn-Brush; 3. Qvintip; 4.Colli-Pee |
1. Vaginal smear; 2. Vaginal smear; 3. Vaginal smear 4. Urine specimen |
Self-sampling | A questionnaire (self-administered paper questionnaire) | >95 % | Among women preferring self-sampling, 53 % would choose urine collection, 38 % vaginal self-collection and 9 % had no preference |
Both urine and vaginal self-samples are well accepted by the study participants |
| Devotta et al., 2023 | Canada, Ontario | Mixed methods | 69 | 30–69 | HerSwab | Vaginal sampling | Self-sampling | A an interviewer-administered survey | – | Some women found HPV self-sampling to be acceptable alternative to CCS | Self-sampling is an alternative to clinical cervical cancer screening |
| Enerly et al., 2016 | Norway/Oslo area | Cross-sectional | 267 | 25–69 | 1.Evalyn brush; 2. Deplphi Screener |
1. Vaginal smear; 2. Vaginal smear |
Self-sampling vs. Clinician-taken sample | A questionnaire (self-administered paper questionnaire) | 88 % | The majority of women found the self-sampling procedure to be easy | Self-sampling has the potential to improve cervical cancer screening attendance |
| Ertik et al., 2021 | Germany/Hannover | Prospective multicenter phase II trial (CoCoss-Trial) | 65 | 24–76 | 1.Evalyn-Brush; 2. FLOQSwab; 3. Colli-Pee FV-5000 |
1. Vaginal smear; 2. Vaginal smear; 3. Urine sample |
Self-sampling vs. Clinician-taken sample | A questionnaire (self-administered paper questionnaire) | 95 % | Only 4.6 % of women preferred the CCS over the self-samples |
All devices were considered easy to use without any difficulties following the written instructions |
| Fujita et al., 2023 | Japan | Randomized | 1,196 | 30–59 | Evalyn-Brush | 1. Vaginal smear; 2. Cervical smear |
Self-sampling vs. Clinician-taken sample | A questionnaire (not specified) | 75.3–––81.3 % | Willingness to undergo screening with a self-collected sample was significantly higher than with CCS | High acceptability of HPV self-sampling was confirmed |
| Gibert et al., 2023 | Spain, Illes Balears | Cross-sectional | 120 | 40–51 | 1. Viba-Brush; 2. Mía by Xytotest; 2. Rovers Cervex-Brush |
1. Vaginal smear; 2. Vaginal smear; 3.Cervical smear |
Self-sampling vs. Clinician-taken sample | A questionnaire (survey) | 91.7 % | The majority of participants considered self-sampling to be beneficial on CCS | Self-sampling was well-accepted by patients |
| Hanley et al., 2016 | Japan/Sapporo | Not reported | 203 | 20–49 | Evalyn brush; |
Vaginal smear; | Self-sampling vs. Clinician-taken sample | A questionnaire (self-administered paper questionnaire) | 90 % | Compared with CCS, women found self-sampling significantly less painful and less embarrassing | Self-sampling was highly acceptable in the studied population |
| Ibáñez et al., 2023 | Spain, Catalonia and Canary Islands | Randomized | 1,158 | 30–65 | Evalyn brush; | Vaginal smear; | Self-sampling vs. Clinician-taken sample | A questionnaire (self-administered paper questionnaire) | 87 % | The majority of all participants “favoured home-based self-sampling approach” for cervical cancer screening | Self-sampling was a highly accepted in Spain |
| Ilangovan et al., 2016 | USA/Florida/ Haitian and Latina women | Not reported | 180 | 30–65 | POI/NIH self-sampler | Vaginal smear; | Self-sampling vs. Clinician-taken sample | A questionnaire (self-administered paper questionnaire) | 67 % | Over 80 % of women agreed HPV self-sampling was “faster, more private, easy to use, and would prefer to use again” | HPV self-sampling was acceptable and feasible to the study participants |
| Islam et al., 2020 | Kenya/ Mombasa | Cohort study | 400 | 19–66 | 1. Evalyn-Brush; 2. Viba brush |
1.Vaginal smear 2.Cervical smear | Self-sampling vs. Clinician-taken sample | Questionnaire (type of survey not specified) | 36 % | 88 % of women agreed that the Evalyn brush was comfortable to use | The possibility self-sampling would improve the utility of cervical cancer screening |
| Ketelaars et al., 2017 | The Netherlands/Dutch population of Nijmegen and ‘s-Hertogenbosch regions |
Cross-sectional | 2,460 | 30–60 | 1.Evalyn brush; 2. Rovers Cervex-Brush |
1. Vaginal smear; 2. Vaginal smear; |
Self-sampling vs. Clinician-taken sample | A questionnaire (online) | 97.1 % | 62.8 % preferred self-sampling over a CCS for the next screening round |
Self-sampling is highly acceptable to women, and a well-accepted alternative to CCS |
| Leeman et al., 2017 | Spain | Cross-sectional | 91 | ≥18 | 1.Colli-Pee™; 2. Evalyn brush |
1.Urine sample; 2. Vaginal smear; |
Self-sampling vs. Clinician-taken sample | A questionnaire (self-administered paper questionnaire) | 90.1 % | The overall rating by all 91 women resulted in an average score of 7.6 out of 10 for CCS, 8.1 for self-sampling (P < 0.005) |
The self-sampling technique was rated as excellent by most of the women |
| Leinonen et al., 2018 | Norway/South East region population | Cross-sectional | 310 | 21–80 | 1.Evalyn brush; 2. FLOQSwab |
1.Vaginal smear; 2. Vaginal smear; |
1 and 2.Self-sampling vs. 3.Clinician-taken sample | A questionnaire (type is not specified) | 90–94.5 % | Patients considered Evalyn Brush easier than FLOQSwab | Both devices were well accepted |
| Levinson et al., 2013 | Peru/Manchay and Iquitos | Not reported | 632 | 30–45 | “Just for Me”self-administered cervicovaginal sampling brush | 1.Vaginal smear; 2.Cervical smear; |
1. Self-sampling vs. 2.Clinician-taken sample | A questionnaire (self-administered paper questionnaire) | 98 % | – | Self-sampling approach had high satisfaction among patients |
| Lichtenfels et al., 2023 | Brazil, São Paulo | Not reported | 73 | 25–65 | SelfCervix | Vaginal smear 2.Cervical smear |
Self-sampling Vs. Clinician collected |
Questionnaire (not specified) | 79.7 % | – | The majority of the study participants would recommend self-sampling to other women |
| Lorenzi et al., 2019 | Brazil/Caucasian, non-Caucasian | Cross-sectional | 116 | ≥21 | Evalyn Brush | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 76.7 % | 12.9 % would prefer CCS | Regardless of age, the participants found self-collection easy to accept |
| Mahomed et al., 2014 | South Africa/urban and rural | Not clarified | 106 | >18 | 1.Evalyn Brush; 2. Delphi Screener |
1.Vaginal smear; 2. Vaginal smear |
Self-sampling | A questionnaire (self-administered paper questionnaire) | 75 % | – | Self-sampling may be an acceptable way to improve cervical cancer screening coverage |
| Ma'som et al., 2016 | Malaysia/Malays, Indian, Chinese | Cross-sectional | 839 | 30–48 | “Just for Me”self-administered cervicovaginal sampling brush | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 68.2 % | Acceptance depends on patients’ age | Urban Malaysian women found self-sampling to be an acceptable alternative to Pap-test |
| Mbatha et al., 2017 | South Africa/KwaZulu-Natal | Cross-sectional | 91 | 16–22 | 1. Dacron swab; 2 Viba Brush |
1.Vaginal smear; 2. Vaginal smear; |
1.Self-sampling vs. 2.Clinician-taken sample | A questionnaire (type is not specified) | 56 % | 44 % indicated preference for CCS | Self-sampling was acceptable to the majority of participants |
| Megersa et al., 2020 | Ethiopia /North Gondar Zone | Qualitative descriptive | 47 | Average age − 36 | Evalyn Brush | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | Low | Fear of using Evalyn brush for self-sampling was found to be the main barrier | Educating women regarding cervical cancer and HPV testing is required |
| Mremi et al., 2020 | Tanzania/ rural Kilimanjaro | Combined cross-sectional and cohort |
1,108 | 25–60 | Evalyn Brush | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) +text messages |
98.9 % | 94.5 % would recommend it to a friend | Self-sampling may have potential to improve cervical cancer screening in LMICs |
| Nishimura et al., 2023 | Japan, Muroran City | Not reported | 953 | 20–50 | 1.Evalyn Brush; 2.Colli-Pee |
1.Vaginal smear; 2.Urine sample; |
1 and 2.Self-sampling | A questionnaire (self-administered) | 88.8 % | 85.5 % - the collection method was easy, 12.9 % - “somewhat challenging” |
The self-sampling method was found to be acceptable |
| Phoolcharoen et al., 2018 | Thailand,Bangkok | Not reported | 247 | 30–70 | 1. Evalyn Brush; 2. Rovers Cervex-Brush |
1. Vaginal smear; 2. Cervical smear |
Self-sampling vs. 2. Clinician-taken sample |
A questionnaire (self-administered paper questionnaire) | 90 % | 80 % of participants reported the overall very good experience of using the self-sample in comparison with CCS | Self-sample HPV testing appears to be highly accepted |
| Ploysawang et al., 2023 | Thailand,Bangkok | Cross-sectional | 265 | 30–60 | Aptima Multitest Swab Specimen Collection Kit | 1. Vaginal smear; 2. Cervical smear |
1.Self-sampling vs. 2. Clinician-taken sample |
A questionnaire (self-administered paper questionnaire) | 66.4–93.6 % | 66.4 % preferred self-sampling for the next screening | Most of the study participants accepted HPV self-sampling |
| Ruel-Laliberté et al., 2023 | Canada, Québec | Cross-sectional | 310 | 21–65 | Roche Dry swab | Cervico-vaginal smear | Self- sampling | A questionnaire (in-person, paper based) | 84.2–95.8 % | 84.2 % - very satisfied and 95.8 % - choose self-sampling as a primary screening method | HPV self-sampling could increase access to cervical cancer screening |
| Sechi et al., 2022 | Italy/Monza | Not specified | 40 | >18 | 1.FLOQSwab; 2. Evalyn Brush; 3.Her swab |
1–3. Vaginal smear; 4. Cervical smear |
1–3.Self-sampling vs. 4.Clinician-taken sample |
A questionnaire (not specified) | 100 % | Almost all the patients would prefer to use vaginal self-sampling compared CCS |
Good acceptance was reported |
| Sechi et al., 2023 | Italy/Sardinia | Cross-sectional | 185 | 34–51 | FLOQSwab; | 1. Vaginal smear; 2. Cervical smear |
1.Self-sampling vs. 2. Clinician-taken sample |
A questionnaire (not specified) | “higher than 60 %” | – | High acceptability of self-collection among women was reported |
| Tiiti et al., 2021 | South Africa/Gauteng Province (black Africans) | Cross-sectional | 527 | ≥18 | 1.SelfCerv Self-Collection Cervical Health Screening Kit; 2. Cervex-Brush Combi |
1. Vaginal smear; 2.Cervical smear; |
1.Self-sampling vs. 2. Clinician-taken sample |
A questionnaire (in-person, paper based) | 90.5 % | 88.4 % of women preferred self-collection | Self-sampling is a potential way to increase primary screening coverage |
| Tranberg et al., 2018 | Denmark/Central Region | Cross-sectional | 213 | 30–59 | Evalyn brush | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 97.2 % | 94.8 % of women reported that self-sampling was comfortable | A high acceptability of home-based self-sampling was reported |
| Tranberg et al., 2020 | Denmark/ Central Denmark Region | Cross-sectional | 216 | 30–59 | 1. Cervex-Brush®; 2. Evalyn® Brush; 3. Genelock |
1.Cervical smear 2. Vaginal smear 3. Urine sample |
Self-sampling vs. Clinician-taken sample | Questionnaire (self-administered paper questionnaire) | 97.3 % | – | Urine collection provides a well-accepted screening option |
| Veerus et al., 2022 | Estonia | Randomized | 1,920 | 37–62 | 1.Qvintip; 2. Evalyn-Brush |
Vaginal smear | Self-sampling | Online questionnaire | High | 98 % of women agreed that self-sampling was easy, 88 % preferred it as a future screening method | The good acceptance of HPV self-sampling among long-term screening non-attenders in Estonia was reported |
| Wedisinghe et al., 2022 | Scotland/ Dumfries and Galloway | Prospective cohort | 313 | 30–60 | Evalyn-Brush | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 70 % | 97 % of women would regularly participate in cervical screening if self-sampling was offered | Offering self-sampling appears to increase cervical cancer screening coverage |
| Winer et al., 2016 | USA/Arizona American Indian | Not reported | 329 | 21–65 | Dacron swab | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 96 % | 62 % of women indicated that they preferred HPV self-sampling to CCS | HPV self-sampling is feasible and acceptable |
| Wong et al., 2018 | China, Hong Gong | Cross-sectional | 68 | 22–59 | Dacron swab | Vaginal smear | Self-sampling vs. Clinician-taken sample | A questionnaire (in-person, paper based) | 70.6 % | Positive attitudes toward self-sampling, however, with some confidence expressed | The study findings showed that self-sampling could improve cervical cancer screening |
| Wong et al., 2020 | China/ Hong Kong | Cross-sectional | 177 | 25–35 and aged ≥ 45 | Evalyn Brush | Vaginal smear | Self-sampling | Questionnaire (type of survey not specified) | 95 % | Acceptance of HPV self-sampling was fairly positive | HPV self-sampling was found to be a good solution to overcome low screening coverage |
| Yoshida et al., 2013 | Lao People’s Democratic Republic | Not reported | 290 | 18–80 | Viba brush | Vaginal smear | Self-sampling | A questionnaire (self-administered paper questionnaire) | 62 % | – | Self-sampling for cervical cancer screening is highly acceptable |
Table footnotes: CCS – clinician-collected sample; LMIC – low- and middle-income countries;