Southern Vietnamese women’s views on HPV vaccination, cervical cancer screening, and HPV self-sampling

Abstract

Cervical cancer remains a significant public health issue in Vietnam, particularly in the South where the incidence is double the national average. However, HPV vaccination and cervical cancer screening uptake remains low in this region. This study explored Southern Vietnamese women’s views on cervical cancer prevention, including HPV self-sampling, a World Health Organization-endorsed screening method. In October-November 2021, six focus groups were conducted with 44 women aged 30–65. A trained researcher who was a native Vietnamese speaker moderated the discussions using a semi-structured guide covering knowledge and attitudes toward cervical cancer prevention. Participants also watched videos on screening methods and shared their views. Discussions were audio-recorded, transcribed, translated to English, and thematically analyzed using Dedoose 9.0.46. Three main themes emerged: (1) barriers to prevention included low knowledge, logistical and psychological challenges, and issues related to healthcare providers; (2) participants viewed HPV self-sampling positively, although concerns about incorrect self-sampling and mailing logistics were noted; (3) participants generally accepted cervical cancer prevention and drew parallels to COVID-19 prevention, suggesting similar public health approaches. These findings suggest that combining HPV self-sampling with strategies used for COVID-19 prevention, including public education, government support, and improved access, could enhance cervical cancer prevention in Southern Vietnam.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-025-16248-2.

Introduction

Cervical cancer is the most common gynecologic cancer globally, with over 600,000 new cases annually¹. The incidence of cervical cancer is inversely associated with a country’s income level: the age-adjusted incidence rates in high, upper-middle, lower-middle, and low-income countries in 2020 were 8.4, 12.8, 16.9, and 23.8 per 100,000 women, respectively². Vietnam is a lower-middle-income country that saw over 4,000 new cervical cancer cases in 2020². Incidence in Southern Vietnam is about 1.5-4 times higher than in Northern Vietnam³, likely due to the cultural differences that persisted since the country’s separation during the Vietnam War³.

Cervical cancer prevention includes Human papillomavirus (HPV) vaccination and cervical cancer screening, both of which are available in Vietnam. Screening methods available in Vietnam include the Papanicolaou (Pap) test, visual inspection with acetic acid (VIA), HPV testing with physician-collected samples, and more recently, HPV self-sampling. HPV self-sampling has been recommended by the World Health Organization (WHO) as a promising approach to accelerate cervical cancer elimination⁴. This method offers several advantages: it is simple, convenient, time-efficient, private, and cost-effective, as it does not require women to visit healthcare facilities while maintaining diagnostic accuracy comparable to HPV testing on physician-collected samples^4,5.

Cervical cancer has been recognized as a national public health priority in Vietnam and there have been initiatives to improve prevention, including pilot screening programs⁶ and the planned introduction of the HPV vaccine into the National Expanded Program on Immunization beginning in 2026⁷. However, despite these emerging efforts, uptake of HPV vaccination and cervical cancer screening remains very low in Southern Vietnam, likely due to the current absence of a fully implemented national screening and vaccination program. A survey in 2021 found that only 4% of Southern Vietnamese women were HPV vaccinated⁸, which is much lower than the WHO’s 2030 goal of 90% full vaccination coverage⁵. Similarly, while the WHO’s 2030 target calls for 70% of women to be screened for cervical cancer by the age of 35⁵, our previous study conducted in 2021 found that only 40% of Southern Vietnamese women in this age group had ever undergone screening⁹.

Previous quantitative surveys, including ours, have identified numerous barriers to HPV vaccination and cervical cancer screening in Southern Vietnam^8–14. However, quantitative surveys alone may not be sufficient to understand the complex and subjective experiences contributing to these barriers. To our knowledge, there has been no qualitative study on barriers to cervical cancer prevention specifically in Southern Vietnam. While some nationwide qualitative studies have examined barriers to HPV vaccination, their findings were not presented by region^15,16. Furthermore, existing qualitative research on HPV vaccination conducted in Northern Vietnam¹⁷ may not be applicable to the Southern population, as suggested by evidence demonstrating regional differences in health perceptions¹⁸. Importantly, while HPV self-sampling has been shown to improve screening uptake and is highly accepted by women in many low-and-middle-income countries (LMICs)^19–36, no study has explored the views on HPV self-sampling among Southern Vietnamese women. Therefore, the current study aimed to fill these gaps by exploring attitudes toward HPV vaccination and cervical cancer screening, including HPV self-sampling, through focus groups of Southern Vietnamese women.

Methods

This study was approved by the Ethics Committee in Biomedical Research at Ho Chi Minh City University of Medicine and Pharmacy (Decisions 446 and 480/HDDD-DHYD, approval dates June 21 and September 29, 2021) and the University of Michigan Health Sciences and Behavioral Sciences Institutional Review Board (HUM00197878, approval date October 4, 2021). All participants provided written informed consent. All methods were performed in accordance with relevant guidelines and regulations. A Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for qualitative studies³⁷ is included as Supplement Table 1.

Table 1.

Characteristics of participants in the focus groups.

	Rural (n = 21)	Urban (n = 23)	p-value1
Age
Mean [standard deviation]	48.0 [11.2]	45.2 [11.3]
Median [Q1-Q3] Min-Max	45 [39–59] 30–65	42 [36.5–54.5] 29–62	0.41
Marital status
Not married	5 (23.8%)	8 (34.8%)
Married	16 (76.2%)	15 (65.2%)	0.64
Self-evaluation if household financial needs were met
Not met at all	4 (19.0%)	5 (21.7%)
Barely met	7 (33.3%)	6 (26.1%)
Sufficiently or more than sufficiently met	10 (47.6%)	12 (52.2%)	0.87
Self-evaluation of cervical cancer knowledge
Not good or not know anything	6 (28.6%)	9 (39.1%)
Average	9 (42.9%)	12 (52.2%)
Good or very good	6 (28.6%)	2 (8.7%)	0.23

¹ p-values from two sample t-tests for continuous variables and chi-squared tests for binary/categorical variables.

Study design

In October and November 2021, six focus groups were conducted in Ho Chi Minh City (Southern Vietnam), including three in the rural district of Can Gio and three in the urban District Four. These areas were selected because they were classified as low-risk for COVID-19 by the local government at the time of the study, thereby making it feasible. Women aged 30–65 with no personal history of cervical cancer were eligible to participate. We included women aged 30–65 because this is the age range recommended by the WHO for cervical cancer screening⁵.

Simultaneously, we conducted a cross-sectional survey of approximately 400 women with the same eligibility criteria and were recruited from the same geographic areas; this study was previously published⁹. Briefly, we collaborated with local district health centers in one rural (Can Gio) and one urban (District 4) district of Ho Chi Minh City to recruit participants for the cross-sectional survey. Using age-stratified sampling across community health centers, recruitment was supported by neighborhood volunteers and community health center staff. The sampling strategy aimed to ensure representation across age groups and both rural and urban settings, which may influence perceptions of cervical cancer prevention. Participants from the cross-sectional survey were invited in person to join this focus group study. Additional participants for this focus group study were recruited through referrals by survey respondents, community health center staff, and neighborhood volunteers, using a purposive sampling strategy to achieve the target group size of 6–8 participants per session.

Six to eight women attended each focus group. Although the eligibility criteria specified an age range of 30–65 years (in alignment with WHO cervical cancer screening guidelines), a 29-year-old woman came to a focus group. Given the minimal deviation from the lower age limit and her enthusiastic engagement, she was not asked to leave the focus group. Focus groups were conducted in a private room at community health centers with only participants and researchers present. All focus groups were conducted in Vietnamese by two native Vietnamese-speaking researchers. The research team included M.T.P., who served as the focus group moderator and, at the time of the focus groups, held a Master of Public Health degree and was a PhD candidate in Epidemiologic Sciences at the University of Michigan (United States). A research assistant, holding a bachelor’s degree in public health, supported the sessions by administering a brief anchoring survey, taking notes during the discussions, and distributing participant incentives. Both the moderator and the research assistant had prior experience conducting population health research.

At the beginning of each focus group session, the moderator welcomed participants and introduced the research purpose and the research team. Participants then reviewed the informed consent documents that also had information on the research purpose, process, benefits, risks, and research team. After providing written informed consent, participants completed a brief anchoring survey in Vietnamese which included questions about their sociodemographic characteristics and cervical cancer knowledge. Participants selected pseudonyms to use in the group discussions to ensure their privacy and confidentiality. For all focus groups, we used a semi-structured guide that covered the following topics: attitudes and knowledge of cervical cancer, experiences with and attitudes towards HPV vaccination and cervical cancer screening methods, cervical cancer stigma, and views on cervical cancer prevention. The focus group guide with accompanying prompts was informed by the focus group protocol from a previous study on cervical cancer prevention³⁸ and underwent a thorough review by our research team to ensure cultural appropriateness. During the focus groups, participants also watched four short videos (each 1–2 min long) with Vietnamese voiceover and subtitles. These videos introduced physician-based screening methods (i.e., Pap test, VIA, HPV testing on physician-collected samples) and HPV self-sampling. Each video clearly illustrated the purpose and procedure of the screening method. For example, one animated video for a Pap test depicted a woman lying on an examination table in a clinic without her lower garments, while a healthcare provider used a speculum to widen the vaginal canal and collect cervical cells with a small swab. It also explained that the sample would be examined under a microscope for abnormal cells, with results typically being available within a few days. Another animated video demonstrated the HPV self-sampling process, showing a step-by-step guide of a woman collecting her own sample in a private home setting and mailing the sample to a laboratory or hospital for HPV testing. The focus group moderator ensured participants understood the content of each video, and participants were invited to share their thoughts after watching each one. A summary of the discussion procedures is provided in Supplement Table 2. Each focus group lasted approximately two hours and each participant received 200,000 Vietnam Dongs (~ US$9).

Table 2.

Descriptive quotes for theme 1- barriers to HPV vaccination and cervical cancer screening. The words in the brackets are the additions by the authors to clarify the context of participants’ quotes.

Sub-theme	Descriptive quotes
1a. Low knowledge of cervical cancer prevention	I think white discharge that comes out too much wears down the uterus and causes cancer. I don’t have any symptoms such as stinky white discharge, so I just clean myself [such as] hand washing. I don’t have any symptoms, so I don’t visit doctors. If I see the color [of the white discharge] turning even slightly bad or [if I see] any symptoms, I will visit doctors. I haven’t been vaccinated [against HPV because] I just heard of them [i.e., HPV and HPV vaccination]. They are new to me.
1b. Structural barriers	I think it [i.e., low HPV vaccination rate] is partly due to financial conditions. One dose cost more than a million [Vietnam Dong] or two million [Vietnam Dong], and we have to get three doses. We want to screen and vaccinate but it is time and money-consuming, while we are busy with working. I don’t feel anything abnormal, so I just stay at home working and taking care of my husband and children, being busy days and nights. If I go [to a hospital] to get screened, I have to spend the whole day and arrange all the house chores [in advance]. If I go to the city [for screening], it will take 2–3 days.
1c. Psychosocial barriers	[I feel] embarrassed [when taking a Pap test] because I have to take off my pants. However, if I am in pain [i.e., having symptoms], I will have to [take a Pap test], I won’t feel embarrassed anymore. If that’s a mild condition, it’s okay [for other women in the examination room to hear]. If that’s a serious condition, people hear it and may spread the news [that I get the disease]. I find this method [i.e., Pap test] has a disadvantage in that if the doctor is not skillful, it will hurt a lot and it may also bleed. Also, if I take this test several times, it can scratch [my vagina], which causes infections. In general, when a person visits a doctor, if they don’t have the disease [i.e., cancer], it’s fine. If they [figure out they] have the disease, they will have a mental breakdown. They will worry if they have enough money to treat [the disease], how they would be, how their children and family would be; that will be a serious mental breakdown! Young people who screened for the first time would think that other women were looking at them [and judging]: “What kind of women have to take this test?” My sister is too young and would feel embarrassed about taking a gynecological exam and an [HPV] test. I don’t know if she has to test [for HPV] before vaccinating. Is it okay to get [HPV] vaccinated? My unmarried daughter asked for my permission to get [HPV] vaccinated but I didn’t allow her. I’m afraid that [HPV] vaccination would make her unable to have children in the future. When I was in high school, I knew about HPV vaccination, but I didn’t vaccinate because my friends said that there were three doses, but we would die after the second dose.
1d. Healthcare workers impact screening attitudes.	Many doctors are irresponsible. For example, when patients take off their pants slowly, they yell at patients. It’s possibly because of their work pressure. Therefore, people are reluctant to visit doctors. If I see a male doctor, I will go home! I visited doctors twice [i.e., for gynecologic examination], but I only met male doctors [so I didn’t get screened]. Women are afraid of male [doctors]. But actually male [doctors] are always more skillful than female [doctors], frankly speaking!

Data analysis

The group discussions were audio recorded, transcribed in Vietnamese, and translated into English by an author (M.T.P) who is a native Vietnamese speaker and a trained epidemiologist in the United States. The English transcriptions were then coded and analyzed using Dedoose 9.0.46³⁹. One focus group in the rural area and one in the urban area were first coded by two authors (M.T.P and L.K.). The codes were compared and discussed to create a codebook, which was then applied to the other four focus groups; a coding tree is presented in Supplement Table 3. The codes were analyzed to identify potential rural-urban differences. The study used thematic analysis to identify themes in participants’ perceptions and experiences. The themes were derived from the data and are presented with participant quotations in the Results section. Two sample t-tests and chi-squared tests were conducted to identify rural-urban differences in the continuous and dichotomous/categorical sociodemographic variables from the anchoring survey, respectively.

Table 3.

Descriptive quotes for theme 2- acceptability of HPV self-sampling. The words in the brackets are the additions by the authors to clarify the context of participants’ quotes.

Sub-theme	Descriptive quotes
2a. Self-sampling overcomes the barriers to physician-based screening methods.	I think for young women, the fourth method [i.e., HPV self-sampling] is more appropriate. First, it is because they have to work. Going to hospitals often takes the whole morning. Second, they would be embarrassed [of visiting doctors for screening], so they should self-collect the sample. That [i.e., HPV self-sampling] is convenient. Sometimes people in remote rural areas can’t visit doctors. Busy people can’t visit doctors. They can send the samples to the hospital [for HPV testing]. […] Similar to COVID-19 [self-testing], we can do it at home, and don’t have to go to dangerous places [i.e., crowded places with high risk of COVID-19 transmission].
2b. Concerns about self-sampling but being willing to try	It [i.e., the self-sampling device] seems a bit stiff. Would it hurt when I inserted it inside [my vagina]? It scares me! […] Putting such a stiff thing inside [my vagina] will hurt a lot. It can even bleed if I’m not careful. We live in remote areas. [If] doctors come [to the community] and guide us [on how to self-sample] the first time and the second time, we will get used to it. Then I can [self-sample] at home the next time. In general, if it [i.e., an HPV self-sampling device] is in the market, I will be able to [self-sample]. It’s like COVID-19 [self-]testing, the one with nose poking. We should self-collect samples at home, they [i.e., healthcare providers] can’t always do it for us.
2c. Concerns of mailing the samples and potential solutions	I can self-sample or I can ask my husband to do it for me, but I think sending [the self-collected sample] via mail is laborious, and I wonder if the fluid is still qualified for testing when it arrives [at the hospital/lab]. If women don’t want to drop the samples off at a post office, they should be able to drop them off at the community health center. The community health center will gather the samples with barcodes on them and give women a receipt. Going to the community health center is less cumbersome than dropping the samples off at a post office.

Results

Forty-four participants attended six focus groups (n = 21 in rural; n = 23 in urban). Rural participants were older than urban participants (mean age = 48.0 vs. 45.2 years, respectively; p = 0.41; Table 1), more likely to be married (76.2% vs. 65.2%; p = 0.64), and more likely to self-indicate that their knowledge of cervical cancer was good or very good (28.6% vs. 8.7%; p = 0.23). However, none of these results was statistically significantly different, possibly due to the small sample size.

Overall, there were 261 codes that fell into three major themes: (1) barriers to HPV vaccination and cervical cancer screening, (2) acceptability of HPV self-sampling, and (3) attitudes toward cervical cancer prevention. There were no differences in the themes between the rural and urban areas; therefore, the findings are presented collectively rather than stratified by setting.

Theme 1: barriers to HPV vaccination and cervical cancer screening

Low knowledge of cervical cancer prevention

Most participants lacked knowledge of cervical cancer’s causes and prevention. The predominant belief was that cervical cancer was caused by poor hygiene and common gynecological issues such as white vaginal discharge, menorrhagia, or infection. As a result, women got screened only when they had what they believed were cervical cancer symptoms such as “stinky white discharge” or irregular menstrual cycles. Women without these symptoms believed keeping their genitals clean was sufficient to prevent cervical cancer. Additionally, many participants were not aware that HPV was the primary cause of cervical cancer and that there was a vaccine available.

Structural barriers

Participants thought that HPV vaccination and cervical cancer screening were unaffordable. Furthermore, they described cervical cancer screening as time-consuming. This included the travel time to and from the healthcare facility, particularly for rural women, and the wait at the facility. As a result, women would lose time working and taking care of their families if they got screened. Another barrier was the increased risk of getting COVID-19 infection when visiting hospitals for screening or vaccination.

Psychosocial barriers

Most participants, particularly young and unmarried women, felt embarrassed when screening using a physician-based method because they had to remove their pants in front of healthcare providers. Additionally, there was fear of a confidentiality breach of their health status; several patients might be called to the examination room simultaneously to save time. Participants were also concerned that getting screened would make people think negatively about their sexual lives. Furthermore, participants had a fear of inserting a speculum inside the vagina during a Pap test, because, as a woman said, “if the doctor is not skillful, it will hurt a lot and it may also bleed.” Moreover, participants were afraid that screening would reveal that they had cancer. A participant explained that when a woman knew they had cervical cancer, “they will worry if they have enough money to treat [the disease], how they would be, how their children and family would be; that will be a serious mental breakdown!”

The reluctance to get cervical cancer screening is also a barrier to getting HPV vaccinated due to the belief that getting a gynecological examination is necessary to be eligible for HPV vaccination. Additionally, participants worried that HPV vaccination might cause severe side effects such as infertility or even death, thus they did not vaccinate themselves and their children. A participant explained: “My unmarried daughter asked for my permission to get [HPV] vaccinated but I didn’t allow her. I’m afraid that [HPV] vaccination would make her unable to have children in the future.”

Healthcare workers impact screening attitudes

Many women were reluctant to get screened due to prior bad experiences with impolite doctors although some participants mentioned that doctors had improved their bedside manners recently. Additionally, although there was a common misconception that “male [doctors] are always more skillful than female [doctors]”, many participants felt embarrassed to visit male doctors for cervical cancer screening. Excerpts from the focus groups for theme 1 are shown in Table 2.

Theme 2: acceptability of HPV self-sampling

Self-sampling overcomes the barriers to physician-based screening methods

Participants thought that HPV self-sampling was simple, convenient, less time-consuming, and less embarrassing because it did not require women to visit healthcare providers. Therefore, participants believed that this method was acceptable, particularly for young, busy women, individuals living in remote areas, and during the COVID-19 pandemic.

Concerns about the self-sampling procedure but being willing to try

Participants feared that self-sampling could scratch their genitals and cause pain, infections, and bleeding. One participant asked: “Would it hurt when I inserted it inside?” Participants were also concerned about not self-collecting their samples correctly, which could lead to inaccurate test results.

However, participants were open to trying self-sampling if guided by doctors. Participants expressed that successfully trying self-sampling would boost their confidence to do it in the future. Interestingly, participants noted similarities between HPV self-sampling and COVID-19 self-testing. Those who lacked confidence in COVID-19 self-testing also felt uncertain about HPV self-sampling, while those confident with COVID-19 self-testing felt similarly about HPV self-sampling.

Concerns about mailing the samples

Participants thought dropping off self-collected samples at post offices was laborious and inconvenient. They suggested alternative methods, such as drop-offs at community centers or home pick-ups. Additionally, there were concerns about packages being lost or damaged during delivery. Furthermore, participants feared that long delivery times would negatively impact the samples, resulting in inaccurate test results. Excerpts from the focus groups for theme 2 are shown in Table 3.

Theme 3: attitudes toward cervical cancer prevention

Universal acceptance of cervical cancer prevention

Participants thought a cervical cancer diagnosis would cause serious problems to their lives and families. It was acknowledged that HPV vaccination was good for health, thus, many participants expressed a desire to vaccinate their children. Similarly, participants saw the advantages of cervical cancer screening because it could rule out the disease or detect the disease early for treatment. Hence, participants accepted screening for cervical cancer despite the barriers.

Successful COVID-19 control approaches in Vietnam should be applied to cervical cancer prevention

Participants suggested that campaigns to promote public knowledge, a key strategy for the successful COVID-19 control in Vietnam, should be applied to cervical cancer prevention. Mass media such as TV, newspapers, videos, banners, or Facebook, were suggested as effective methods to improve public knowledge. Participants also highlighted the important roles of community leaders and Women’s Unions to improve community members’ knowledge. Additionally, women believed healthcare professionals should be engaged because, as one participant said, “they are knowledgeable, more people will listen to them”. Furthermore, peer modeling was considered important since peers can assure people about the safety and effectiveness of HPV vaccination, share their experiences with screening, and accompany others to get screened.

Enhancing access to screening and vaccination, another successful COVID-19 control strategy, was suggested for cervical cancer prevention. In fact, many participants stated that they attended free community cervical cancer screening programs when available. Likewise, women thought that if HPV vaccine costs were fully or partially covered by the government, more people would get vaccinated. Participants believed these above strategies would make cervical cancer prevention successful in Southern Vietnam as stated by a participant, “more and more people will accept it”, similar to COVID-19 control. Excerpts from the focus groups for theme 3 are shown in Table 4.

Table 4.

Descriptive quotes for theme 3- attitudes toward cervical cancer prevention. The words in the brackets are the additions by the authors to clarify the context of participants’ quotes.

Sub-theme	Descriptive quotes
3a. Universal acceptance of HPV vaccination and cervical cancer screening	Actually, I have an aunt who had cervical cancer and had to get rid of everything. I can’t imagine what “getting rid of everything” means, but I heard that there was nothing left for having sex, which her husband disliked. When her husband disliked it, there was no family happiness anymore. Therefore, although not many people know about it [i.e., cervical cancer], it is very dangerous. When we get rid of everything, our husbands won’t live with us anymore, they will go out [to find someone else for sex]. That is related to our happiness. Therefore, I will vaccinate my daughter in the future. I think screening must hurt. People who haven’t done it before and who don’t know about it must feel pain. Screening is to check our health, check the disease, in order to treat it, prevent it, and so on. So, I compare the two pains and find that the pain after we get the disease is much worse [than the pain from screening], it is also related to our lives. Therefore, we’d better screen to find ways to treat the disease. If we detect it early, we can treat it completely.
3b. Successful COVID-19 control approaches in Vietnam should be applied for cervical cancer prevention.	We should have a media campaign [to improve cervical cancer prevention] because this disease is not only about women, we have to approach men as well so that they know how to prevent it for their wives. We should also learn the same propaganda like the one for COVID [control]. I think there should be mass media, for example, like I said earlier, newspapers or community speakers, to make it popular so that people can listen and understand how dangerous the disease is, and that they should vaccinate to protect themselves. We should do mass media like that. Then we should have the People’s Committee, local government, the Women’s Union, and community leaders to propagate to people in the community specifically so that they can understand deeply that the disease is dangerous and that they need to get vaccinated. We should encourage people to screen early. The most effective people to encourage them are healthcare professionals because they are knowledgeable and more people will listen to them. If it is possible, if the government has money, they should have [all] girls at the eligible ages vaccinated for free or reduce the vaccine price for them. For example, they should have all girls at school vaccinated. In the beginning, all vaccines are like that. For example, COVID vaccines, at first, people were afraid, but then the fear went away later. At first, they will be [skeptical of cervical cancer screening and HPV vaccination], but more and more people will [accept it].

Discussion

In this qualitative study on the views of Southern Vietnamese women towards cervical cancer prevention, several barriers to cervical cancer screening among Southern Vietnamese women were identified, including lack of knowledge as well as logistical and psychological barriers. The findings from this qualitative study complement those from our previous cross-sectional survey in the same population⁹. Our survey revealed that lack of knowledge was the most common reason for not getting screened, with 52% of participants stating they had no reason to screen⁹. This focus group study provided deeper insights, revealing beliefs that cervical cancer was caused by poor hygiene and could be prevented by keeping genitals clean. Both the survey and focus groups identified cost, time, interference with family obligations, embarrassment, fears of pain and others’ criticisms of their sexual life as barriers to screening⁹. The current focus group study highlighted additional barriers, including the risk of COVID-19 infections when visiting hospitals, concerns about confidentiality breaches of their health status, healthcare providers’ poor manners, and embarrassment about visiting male providers. To improve cervical cancer screening uptake in Southern Vietnam, it is essential to raise public knowledge and implement innovative approaches that address logistical and psychological barriers identified in this study.

Our current study found that HPV self-sampling, a novel screening approach, has the potential to improve cervical cancer screening uptake in Southern Vietnam. After watching a short video describing HPV self-sampling, participants expressed positive attitudes towards this approach, perceiving it as a more convenient, less time-consuming, and less embarrassing screening method. However, there were concerns about this screening method, particularly regarding the possibility of improper self-collection, discomfort, and mailing logistics. Experiences from similar research in other LMICs^21,28,40 suggest that concerns about improper self-sampling and discomfort may diminish once women gain hands-on experience with self-sampling, rather than just watching a video. Additionally, participants in our study associated HPV self-sampling with COVID-19 self-testing, a process with which they are now familiar, which may facilitate higher acceptance of HPV self-sampling.

Concerns about mailing logistics and sample reliability related to HPV self-sampling were also discussed. In Vietnam, domestic delivery typically takes 5–7 days but can extend to 10 days for very remote areas⁴¹. However, the rapid development of e-commerce in Vietnam, particularly after the COVID-19 pandemic, has led to the expansion of express delivery services that significantly reduce delivery time, although these services are currently more accessible in urban and suburban areas⁴². Regardless, self-collected samples are analytically stable with respect to HPV detection over an extended period. For example, self-collected samples using Evalyn Brush (Rovers Medical Devices) remain stable for up to 32 weeks⁴³. To improve acceptance, it is important to provide clear information to reassure women about the reliability of samples during mailing. Future studies should also explore if alternative sample return options, such as drop-off points at community centers or home pick-ups, are feasible and convenient for women.

This qualitative study also identified several important barriers to HPV vaccination in Southern Vietnam, including limited knowledge about the vaccine, concerns about side effects, and financial constraints; these findings are broadly consistent with previous quantitative surveys^8,10–14. Interestingly, our current study uncovered a previously unreported belief that a gynecological examination is necessary for HPV vaccination, which has not been reported in previous studies. This misconception may be influenced by experiences during the COVID-19 pandemic, when a negative test result was often required for COVID-19 vaccination. Our findings on barriers to HPV vaccination are especially timely and relevant, as Vietnam is set to incorporate the HPV vaccine into its National Expanded Program on Immunization starting in 2026⁷. While this national rollout is expected to alleviate financial barriers, its success will also depend on complementary efforts to raise public awareness and address persistent concerns about vaccine safety and side effects. Targeted educational campaigns and community engagement initiatives will be essential to ensure high uptake and public trust in the vaccination program.

The age range of participants in our study (30–65 years) aligns with the WHO’s recommended age group for cervical cancer screening but does not correspond to the primary target group for HPV vaccination, which is typically girls and young women aged 9–26⁵. However, previous studies have shown that Vietnamese women in this older age group often play a key role in health-related decision-making, including HPV vaccination, for younger family members^44,45. This is aligned with our findings, which showed that participants had a significant influence on their children’s and younger sisters’ decisions about HPV vaccination. Therefore, their perspectives are critical for designing culturally appropriate, community-based intervention strategies to improve HPV vaccination uptake.

Vietnam was among the countries that successfully controlled the COVID-19 pandemic; the COVID-19 vaccination rate in Vietnam was 33% higher than the average among all LMICs (92% vs. 69%), while the mortality rate was ~ 25% lower (440 vs. 605 per 1,000,000)⁴⁶. Participants in our current study recommended adapting successful COVID-19 control strategies for cervical cancer prevention. One key COVID-19 control strategy was engagement with community health workers. There are ~ 97,000 health workers at ~ 11,000 community health centers in Vietnam⁴⁷. Community health workers were crucial in disseminating COVID-19 prevention information and conducting contact tracing to ensure follow-up care^48,49. This approach could enhance cervical cancer prevention in Southern Vietnam as lack of knowledge is a common barrier to HPV vaccination and cervical cancer screening in this population^8,9. Furthermore, participants emphasized healthcare providers as an influential information source for cervical cancer prevention. Similarly, 85% of participants in our previous survey stated that they would get screened if recommended by healthcare professionals⁹. Likewise, a survey of 648 women in Can Tho, an area in Southern Vietnam, found that 60% of participants felt advice from healthcare professionals would influence their decision to receive HPV vaccines⁸.

This is the first qualitative study to explore barriers to cervical cancer prevention in Southern Vietnam and the first to explore women’s views on HPV self-sampling in this population. A strength of this study is the inclusion of videos describing different screening approaches to minimize confusion regarding the screening methods. Additionally, the inclusion of both rural and urban participants enabled the exploration of potential geographic differences; however, no rural-urban disparities were observed. This may reflect shared cultural beliefs and common barriers across settings, though the absence of differences could also be due to the small sample size. Despite this limitation, our study offers valuable insights with clear implications for improving cervical cancer prevention in Southern Vietnam. Future research should investigate geographic, ethnic, and subcultural variations, particularly among underserved or minority populations in remote areas, to inform more tailored prevention strategies.

Conclusions

The current study revealed high acceptance of cervical cancer prevention among Southern Vietnamese women despite barriers. Although there were concerns regarding HPV self-sampling, participants showed overall positive attitudes toward this screening approach. These positive attitudes, coupled with the experience with COVID-19 self-testing, suggest that HPV self-sampling could improve cervical cancer screening uptake in this population. Future studies should integrate HPV self-sampling and leverage the successful COVID-19 control strategies, including public knowledge promoting campaigns, local government and healthcare provider engagement, and efforts to improve access to screening and vaccination.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

Conceptualization, M.T.P., P.L.A., and C.L.P.; methodology, M.T.P., P.L.A., and C.L.P.; formal analysis, M.T.P. and L.K.; investigation, M.T.P., P.L.A., and C.L.P.; resources, M.T.P., P.L.A., and C.L.P.; writing—original draft preparation, M.T.P. and C.L.P.; writing—review and editing, M.T.P., P.L.A., L.K., A.W.L., and C.L.P.; supervision, P.L.A. and C.L.P.; project administration, M.T.P., P.L.A., and C.L.P.; funding acquisition, M.T.P.

Funding

This research was funded by multiple sources from the University of Michigan, including the Rackham International Research Award (to MTP); the Rackham Graduate Student Research Grant (to MTP); the Simson Family Graduate Student Fellowship from the Center for Education for Women (CEW+) (to MTP); the Mary Sue & Kenneth Coleman Student Global Experience Scholarship (to MTP); the Global Public Health Grant for pre-dissertation research from the Office of Global Public Health (to MTP); and the Department of Epidemiology, School of Public Health (to MTP). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data availability

The data that support the findings of this study are available from the corresponding author but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the corresponding author upon reasonable request and with permission of the Ethics Committee in Biomedical Research at the Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.

Declarations

Competing interests

The authors declare no competing interests.

Conflict of interest

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.