Abstract
Background
Human papillomavirus (HPV) self-sampling has emerged as a potential alternative approach for cervical cancer screening. However, limited evidence is available regarding women’s experiences and future screening preferences following actual self-sampling.
Objective
To evaluate women’s real-life experiences with HPV self-sampling and identify factors associated with future screening preferences in a Turkish population with actual self-sampling experience.
Methods
This cross-sectional, interview-based study was conducted at the Obstetrics and Gynecology Outpatient Clinic of Kırşehir Training and Research Hospital, Türkiye, between July 2025 and May 2026. HPV self-sampling was offered to 850 eligible women aged 30–65 years, of whom 500 voluntarily accepted and completed self-sampling and subsequent face-to-face interviews (participation rate, 58.8%). Experiences and future screening preferences were assessed using a culturally adapted questionnaire based on the Theoretical Framework of Acceptability. Multivariable binary logistic regression with backward likelihood-ratio selection was used to identify factors associated with preference for clinician-based screening.
Results
Participants reported highly favorable experiences with HPV self-sampling: 81.0% rated the experience as good or very good, 83.8% felt moderately or very confident in performing the test correctly, and 80.2% considered the procedure moderately or very easy to perform. Nevertheless, 49.6% preferred clinician-based screening for future cervical cancer screening, whereas 46.2% preferred HPV self-sampling at home and 4.2% were undecided. Higher educational level was significantly associated with a lower likelihood of preferring clinician-based screening compared with primary school education (high school: OR=0.355, 95% CI: 0.213–0.593; university: OR=0.326, 95% CI: 0.190–0.558; both p<0.001), whereas age was not significantly associated with screening preference. The final model had modest explanatory power (Nagelkerke R2=0.093).
Conclusion
HPV self-sampling was highly acceptable among women with actual self-sampling experience; however, favorable experiences did not necessarily translate into a preference for self-sampling in future screening. Educational level was associated with screening preference, although the modest explanatory power of the model suggests that additional factors may influence women’s choices. HPV self-sampling may therefore be most appropriately considered as a complementary screening option that preserves patient choice rather than as a universal replacement for clinician-based screening.
Keywords: HPV self-sampling, cervical cancer screening, acceptability, screening preference, Türkiye
Graphical Abstract
Introduction
Cervical cancer remains a significant cause of morbidity and mortality worldwide despite the implementation of effective screening programs and the widespread use of human papillomavirus (HPV) vaccination. Persistent infection with high-risk HPV is the primary etiological factor in the development of cervical cancer, and HPV-based screening has become the cornerstone of early detection and prevention strategies.1 However, the effectiveness of cervical cancer screening programs depends largely on participation rates, which remain suboptimal in many countries, with a substantial proportion of eligible women not attending regular screening.2 In line with the World Health Organization’s Global Strategy to Accelerate the Elimination of Cervical Cancer, increasing participation in organized cervical cancer screening has become a global public health priority.3 Consequently, identifying acceptable, accessible, and patient-centered screening approaches is considered essential for achieving cervical cancer elimination targets.4
Participation in cervical cancer screening is influenced by multiple emotional, practical, and socioeconomic factors. Emotional barriers such as embarrassment, anticipated pain, fear, and anxiety, together with practical obstacles including time constraints, limited access to healthcare services, and difficulties navigating appointment systems, have consistently been identified as major contributors to non-attendance.2,5 Furthermore, lower socioeconomic status and limited educational attainment are associated with reduced participation in cervical cancer screening, contributing to persistent health inequalities.1,5
HPV self-sampling has emerged as a promising patient-centered strategy to overcome many of these barriers. Beyond improving screening uptake, self-sampling enhances women’s autonomy, privacy, convenience, and sense of control while maintaining high diagnostic accuracy when validated PCR-based HPV assays are used.2,6 These advantages make HPV self-sampling a promising strategy for increasing screening participation among underscreened and never-screened women.
In Türkiye, cervical cancer screening is provided free of charge through a nationwide program coordinated by the Ministry of Health. HPV-DNA–based screening is recommended for women aged 30–65 years and is delivered through Cancer Early Diagnosis, Screening and Training Centers (KETEM), Family Health Centers, and Community Health Centers (Turkish Ministry of Health). Women with a negative HPV test are advised to undergo repeat screening at five-year intervals. Despite the nationwide availability of these services, participation in cervical cancer screening remains below desired levels, highlighting the need for complementary strategies to improve screening uptake and accessibility.7 However, the successful implementation of HPV self-sampling depends not only on its diagnostic performance but also on women’s experiences, confidence in performing the test, and willingness to use self-sampling in future screening rounds.6,8 Currently, HPV self-sampling is not included as a routine component of the national cervical cancer screening program in Türkiye, and its role in this context remains to be further explored.
In recent years, HPV self-sampling has gained increasing attention as an alternative approach for cervical cancer screening, particularly for improving accessibility and reducing screening-related barriers. Growing evidence indicates that self-sampling can increase screening participation among underscreened and never-screened women while providing greater privacy, convenience, and autonomy without compromising diagnostic performance when validated HPV assays are used.2,6,8 Reflecting this growing body of evidence, recent international guidelines and implementation studies have supported the integration of HPV self-sampling into organized cervical cancer screening programs.1,9 Consequently, several countries, including Australia, the Netherlands, and Sweden, have incorporated HPV self-sampling into their national cervical cancer screening strategies, demonstrating the feasibility of large-scale implementation.9,10
Despite these advances, important evidence gaps remain. Although numerous studies have demonstrated the diagnostic accuracy and high hypothetical acceptability of HPV self-sampling, relatively few have evaluated women’s experiences after actual self-sampling and how these experiences influence future screening preferences. Emerging evidence suggests that high acceptability does not necessarily translate into a preference for self-sampling in future screening. Many women report positive experiences with self-sampling but continue to prefer clinician-based screening because of concerns regarding test accuracy, confidence in sample collection, and trust in self-collected results.2,6,8 To our knowledge, no previous study from Türkiye has evaluated women’s real-life experiences following actual HPV self-sampling and their subsequent screening preferences. Understanding these behavioral determinants is essential for the successful implementation of HPV self-sampling within organized cervical cancer screening programs.
Previously, our research group evaluated the theoretical acceptability of HPV self-sampling among Turkish women who had undergone clinician-collected cervical screening.11 While the findings demonstrated high theoretical acceptability, participants had not experienced HPV self-sampling in practice, leaving uncertainty as to whether favorable attitudes would translate into positive real-life experiences and future screening preferences. Therefore, the present study aimed to evaluate women’s real-life experiences following HPV self-sampling and to identify factors associated with future screening preferences after actual self-sampling in a Turkish population. The findings may provide evidence to support the future integration of HPV self-sampling into the national cervical cancer screening program in Türkiye.
Methods
Study Design and Setting
This cross-sectional, interview-based study was conducted at the Obstetrics and Gynecology Outpatient Clinic of Kırşehir Training and Research Hospital, Kırşehir, Türkiye. Data were collected between July 2025 and May 2026.
Participant Recruitment
Between July 2025 and May 2026, HPV self-sampling was offered to 850 eligible women aged 30–65 years attending the outpatient clinic. Of these, 500 women voluntarily accepted participation and completed HPV self-sampling, corresponding to a participation rate of 58.8%. The reasons for non-participation among the remaining eligible women were not systematically recorded; therefore, specific reasons for non-participation could not be determined. Participants in the present study were recruited from this self-sampling cohort and completed face-to-face interviews regarding their experiences and future screening preferences.
Inclusion and Exclusion Criteria
Women were eligible for inclusion if they were aged 30–65 years, had previously had sexual intercourse, had participated in the previous HPV self-sampling study, and had personally performed HPV self-sampling. For the purposes of this study, sexual activity was defined as having had sexual intercourse at least once. Pregnant women, women with a history of gynecological premalignant or malignant disease, and women who were unable to understand or communicate in Turkish were excluded.
Sample Size
No formal a priori sample size calculation was performed because the present study included all eligible women who voluntarily accepted HPV self-sampling during the study period and completed the previously established cohort. Therefore, the available cohort determined the final sample size (n = 500).
Data Collection
Data were collected through face-to-face interviews conducted by the investigator in a private room at the Obstetrics and Gynecology Outpatient Clinic immediately after completion of the HPV self-sampling procedure and the clinical examination, during the same clinical visit. Interviews were performed between July 2025 and May 2026 using a structured questionnaire to evaluate women’s experiences, perceptions, and future screening preferences regarding HPV self-sampling. Sociodemographic characteristics and screening-related information were also recorded. For screening history and previous colposcopy history, responses were categorized as “Unknown” when participants were unable to recall whether they had previously undergone the respective procedure.
Questionnaire
The questionnaire was based on the Theoretical Framework of Acceptability (TFA) developed by Marlow et al The original English questionnaire was translated into Turkish by the investigator. The translated version was reviewed by an independent academic fluent in both English and Turkish. Subsequently, the Turkish version was back-translated into English and compared with the original questionnaire to ensure conceptual consistency. The translation process aimed to preserve the conceptual equivalence of the original questionnaire rather than achieve a literal word-for-word translation. Following this process, the questionnaire was culturally adapted for use in the Turkish population. The original English questionnaire, the Turkish version, and permission for use are provided in the Supplementary Material. Although the questionnaire underwent translation and cultural adaptation, formal psychometric validation was not performed.
Statistical Analysis
Statistical analyses were performed using SPSS version 29.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize participant characteristics and questionnaire responses. Continuous variables were reported as mean ± standard deviation (SD), while categorical variables were presented as frequencies and percentages.
Associations between categorical variables were analyzed using the chi-square test. Binary logistic regression analysis was performed to evaluate factors associated with participants’ screening preferences. The response “I would prefer clinician-based screening” was coded as the event category. Participants who were undecided regarding their future screening preference (n=21) were excluded from the binary logistic regression analysis; therefore, the regression analysis was restricted to participants who expressed a definite preference for either clinician-based screening or HPV self-sampling (n=479). All candidate variables were initially entered into the multivariable logistic regression model. A backward stepwise selection procedure based on the likelihood ratio (Backward LR) method was subsequently applied to derive the final model. Variables that did not contribute to the model were sequentially removed, with age and educational level remaining in the final model. Educational level was entered as a categorical variable, with primary school education serving as the reference category.
The overall significance of the final model was evaluated using the Omnibus test of model coefficients, while model fit was assessed using the Hosmer–Lemeshow goodness-of-fit test. Model explanatory power was evaluated using Cox and Snell R2 and Nagelkerke R2 coefficients. Regression coefficients were reported as odds ratios (ORs) with 95% confidence intervals (95% CIs). Model classification performance was assessed based on the overall correct classification rate. A two-sided p-value of <0.05 was considered statistically significant for all analyses.
As a sensitivity analysis, an expanded multivariable logistic regression model was additionally fitted to examine the robustness of the primary findings after adjustment for further potentially relevant participant characteristics. The model included age, education level, relationship status, previous cervical screening history, and previous colposcopy history. The outcome definition was identical to that used in the primary model, with preference for clinician-based screening coded as the event; participants who were undecided were excluded.
Ethical Considerations
Participants included in the present study were recruited from a previously conducted self-sampling study, for which ethical approval had been obtained from the Health Sciences Scientific Research Ethics Committee (Date: 22 July 2025; Approval No: 2025–12/151).
Ethical approval for the present study was obtained from the Health Sciences Scientific Research Ethics Committee of Kırşehir Ahi Evran University (Date: 23 December 2025; Approval No: 2025–20/264).
All procedures were conducted in accordance with the Declaration of Helsinki, and written informed consent was obtained from all participants prior to data collection.
Results
Between July 2025 and May 2026, HPV self-sampling was offered to 850 eligible women attending the outpatient clinic. Of these, 500 women voluntarily accepted participation and completed HPV self-sampling, corresponding to a participation rate of 58.8%. These 500 women subsequently completed the face-to-face interview and were included in the final analysis. Sociodemographic and screening-related characteristics of the participants are presented in Table 1. The largest age group consisted of women aged 40–49 years (33.0%), followed by those aged 30–34 years (24.4%) and 35–39 years (22.4%). Most participants were married (93.8%). Regarding educational status, 31.4% were university graduates, while 28.8% had completed high school education.
Table 1.
Sociodemographic and Screening-Related Characteristics of Women with Prior HPV Self-Sampling Experience
| Variable | n (%) |
|---|---|
| Age groups | |
| 30–34 | 122 (24.4) |
| 35–39 | 112 (22.4) |
| 40–49 | 165 (33.0) |
| 50–59 | 85 (17.0) |
| 60–65 | 16 (3.2) |
| Marital status | |
| Single | 3 (0.6) |
| Married | 469 (93.8) |
| Widowed | 26 (5.2) |
| Educational level | |
| Primary school | 126 (25.2) |
| Secondary school | 73 (14.6) |
| High school | 144 (28.8) |
| University | 157 (31.4) |
| Screening status | |
| First screening | 209 (41.8) |
| Second screening | 181 (36.2) |
| Third screening | 56 (11.2) |
| Fourth screening | 46 (9.2) |
| Unknown | 6 (1.2) |
| Previous colposcopy history | |
| Yes | 62 (12.4) |
| No | 403 (80.6) |
| Unknown | 35 (7.0) |
In terms of screening history, 41.8% of participants reported undergoing cervical cancer screening for the first time, whereas 36.2% reported a second screening experience. Previous colposcopy history was reported by 12.4% of participants.
Women generally reported highly positive experiences with HPV self-sampling (Table 2). The majority of participants rated the procedure as good or very good (81.0%). Most women reported little or no discomfort (87.0%), dissatisfaction (90.8%), embarrassment (86.6%), or anxiety (77.8%) related to the procedure. In addition, 83.8% of participants reported feeling moderately or very confident in performing the test correctly, and 80.2% considered the procedure moderately or very easy to perform.
Table 2.
Women’s Experiences and Perceived Usability of HPV Self-Sampling
| Variable | n (%) |
|---|---|
| Self-sampling experience rated as good or very good | 405 (81.0) |
| Reported little or no discomfort during self-sampling | 435 (87.0) |
| Reported little or no dissatisfaction with self-sampling | 454 (90.8) |
| Reported little or no embarrassment during self-sampling | 433 (86.6) |
| Reported little or no anxiety during self-sampling | 389 (77.8) |
| Felt moderately or very confident in performing the test correctly | 419 (83.8) |
| Found the self-sampling procedure moderately or very easy to perform | 401 (80.2) |
Despite these positive experiences, future screening preferences demonstrated a more heterogeneous distribution (Table 3). Nearly half of the participants preferred clinician-based cervical cancer screening (49.6%), while 46.2% preferred HPV self-sampling at home. A small proportion of participants remained undecided (4.2%).
Table 3.
Future Screening Preferences Among Women with Prior HPV Self-Sampling Experience
| Preference | n (%) |
|---|---|
| Prefer clinician-based screening | 248 (49.6) |
| Prefer HPV self-sampling at home | 231 (46.2) |
| Undecided | 21 (4.2) |
Binary logistic regression analysis was performed to evaluate factors associated with preference for clinician-based screening (Table 4). The response “preference for clinician-based screening” was defined as the event category. All candidate variables were initially entered into the model and backward stepwise selection using the likelihood ratio (Backward LR) method was applied. Following the selection procedure, age and educational level remained in the final model. The overall regression model was statistically significant (Omnibus test: χ2=34.678, p<0.001). The Nagelkerke R2 value was 0.093, indicating modest explanatory power of the model. The Hosmer–Lemeshow goodness-of-fit test indicated acceptable model fit (p=0.164).
Table 4.
Binary Logistic Regression Analysis of the Association Between Age, Educational Level, and Preference for Clinician-Based Screening
| Variable | B | Wald | p-value | OR | 95% CI |
|---|---|---|---|---|---|
| Age | 0.004 | 0.135 | 0.714 | 1.005 | 0.981–1.029 |
| Educational level | 28.606 | <0.001 | |||
| Middle school | 0.055 | 0.028 | 0.866 | 1.057 | 0.556–2.010 |
| High school | −1.036 | 15.696 | <0.001 | 0.355 | 0.213–0.593 |
| University | −1.122 | 16.716 | <0.001 | 0.326 | 0.190–0.558 |
Notes: Model fit indices: Omnibus χ2=34.678, p<0.001; Hosmer–Lemeshow χ2=11.726, p=0.164; Nagelkerke R2=0.093; correct classification rate=62.6%. Reference category: Primary school education. Analysis sample: n=479; participants with an “Undecided” screening preference (n=21) were excluded from the binary logistic regression analysis.
Age was not significantly associated with preference for clinician-based screening (OR=1.005, 95% CI: 0.981–1.029, p=0.714). In contrast, educational level was significantly associated with screening preference (Wald=28.606, p<0.001). Compared with women with primary school education, participants with high school education were significantly less likely to prefer clinician-based screening (OR=0.355, 95% CI: 0.213–0.593, p<0.001). Similarly, university graduates demonstrated a significantly lower likelihood of preferring clinician-based screening (OR=0.326, 95% CI: 0.190–0.558, p<0.001).
Sensitivity Analysis
In the expanded multivariable model (n=479), the association between education level and future screening preference remained significant after adjustment for age, relationship status, previous cervical screening history, and previous colposcopy history. Compared with women with primary education or lower, those with high-school education (OR=0.376, 95% CI: 0.221–0.639, p<0.001) and university education (OR=0.321, 95% CI: 0.184–0.561, p<0.001) had lower odds of preferring clinician-based screening. Previous cervical screening history was also independently associated with screening preference (OR=0.489, 95% CI: 0.321–0.746, p=0.001), whereas age, relationship status, and previous colposcopy history were not statistically significant. The expanded model yielded a Nagelkerke R2 of approximately 0.130.
Discussion
In the present study, women with actual prior experience of HPV self-sampling reported highly favorable perceptions of the procedure. Most participants considered self-sampling easy to perform, reported little or no discomfort, embarrassment, dissatisfaction, or anxiety, and expressed confidence in their ability to perform the test correctly. Nevertheless, these positive experiences did not translate into a clear preference for self-sampling in future screening: 49.6% of participants preferred clinician-based screening, whereas 46.2% preferred HPV self-sampling at home. Educational level was significantly associated with screening preference, while age was not. Taken together, these findings highlight an important distinction between procedural acceptability and future screening preference, suggesting that a positive experience with self-sampling alone may not be sufficient to shift women’s preferences away from clinician-based screening.
The high acceptability observed in the present study is consistent with the growing body of evidence demonstrating favorable experiences with HPV self-sampling. Previous studies have shown that self-sampling is generally perceived as convenient, private, and easy to perform, and may reduce practical and emotional barriers associated with clinician-based cervical screening. Importantly, evidence from implementation studies indicates that offering self-sampling can increase screening participation, particularly among women who are underscreened or who do not routinely attend clinician-based screening. The recent YouScreen implementation trial further demonstrated the feasibility of integrating self-sampling into an organized cervical screening program by offering the option to non-attenders in routine primary care. Together, these findings support HPV self-sampling as an acceptable and feasible complementary approach to conventional clinician-based screening, while emphasizing its particular potential for reaching women who might otherwise remain unscreened.2,8,12
Despite the favorable experiences reported in our study, nearly half of the participants continued to prefer clinician-based screening. This apparent discrepancy between procedural acceptability and future screening preference has also been observed in previous studies and may reflect concerns that extend beyond the practical experience of collecting the sample. Women may perceive clinician-collected samples as more reliable or accurate, may remain uncertain about whether they have collected an adequate sample themselves, or may value the reassurance provided by direct contact with a healthcare professional. Indeed, previous research has identified concerns about test accuracy, correct sample collection, and confidence in self-collected results as important factors influencing women’s willingness to use HPV self-sampling. Marlow et al similarly reported that, even among women participating in a clinical validation study of HPV self-collection devices, attitudes toward being offered self-sampling did not necessarily imply a uniform preference for self-sampling over clinician collection. These findings suggest that reducing the physical and practical barriers to screening may not, by itself, be sufficient to change screening preferences; clear information regarding test reliability, appropriate instructions for sample collection, and reassurance about the validity of self-collected samples may also be important when self-sampling is introduced into routine screening programs.2,5
An important contribution of the present study is that acceptability and future screening preferences were evaluated after women had actually performed HPV self-sampling, rather than on the basis of a hypothetical description of the procedure. In our previous study of 302 Turkish women who had undergone clinician-based cervical screening but had not performed HPV self-sampling, attitudes toward self-sampling were assessed as a theoretical screening option.11 In contrast, the present study included 500 women who had personally completed HPV self-sampling and were interviewed immediately after the self-sampling procedure and clinical examination during the same visit. This design allowed women’s perceptions of usability, discomfort, embarrassment, anxiety, confidence, and future screening preference to be evaluated on the basis of direct experience. The findings therefore extend our previous observations by demonstrating that favorable attitudes toward self-sampling are also evident after actual use, while additionally showing that a positive real-life experience does not necessarily result in a preference for self-sampling over clinician-based screening. This comparison is descriptive and is intended to contextualize the present findings rather than represent a direct statistical comparison between the two study populations.11
Educational level emerged as an important factor associated with future screening preference. Compared with women with primary school education, those with high school or university education were significantly less likely to prefer clinician-based screening, whereas age was not significantly associated with screening preference. Educational attainment may influence how women access, understand, and evaluate health information and may therefore contribute to their willingness to perform screening procedures independently. However, the explanatory power of the final regression model was modest (Nagelkerke R2=0.093), indicating that the variables retained in the model accounted for only a limited proportion of the variability in screening preference. This suggests that screening preference is likely influenced by additional factors not captured in the present analysis. Health literacy, perceived accuracy of self-collected samples, trust in self-sampling, reassurance derived from healthcare professional involvement, and other psychosocial or behavioral factors may contribute to women’s decisions regarding future screening methods. As these factors were not directly measured in the present study, their potential roles should be considered hypothesis-generating rather than established explanations. Future studies incorporating these dimensions may provide a more comprehensive understanding of the determinants of women’s preferences for self-sampling versus clinician-based screening.5,12,13
The sensitivity analysis further supported the robustness of the association between education level and future screening preference after adjustment for additional participant characteristics. Previous cervical screening history was also associated with preference in the expanded model, suggesting that prior engagement with cervical screening may contribute to subsequent screening choices. However, even the expanded model explained only a modest proportion of the variability in preference (Nagelkerke R2≈0.130). Accordingly, these findings should be interpreted as associations rather than causal relationships, and other unmeasured individual, psychosocial, and healthcare-related factors are likely to contribute to screening preferences.
From an implementation perspective, these findings have important implications for the potential integration of HPV self-sampling into organized cervical cancer screening programs in Türkiye. The high acceptability observed after actual use supports the feasibility of offering self-sampling as an additional screening option; however, the continued preference for clinician-based screening among nearly half of the participants suggests that self-sampling should complement rather than necessarily replace clinician-based approaches. A choice-based strategy, in which women are offered either self-sampling or clinician-based sampling according to their preferences, may therefore be more appropriate during initial implementation. Such an approach should be accompanied by clear instructions on sample collection, accessible information regarding the reliability of validated HPV self-sampling methods, and pathways for professional support when needed. Particular attention may also be required to ensure that information and instructions are understandable across different educational levels. Integrating these elements into organized screening pathways may help preserve patient choice while allowing self-sampling to reduce practical and emotional barriers for women who are reluctant or unable to attend conventional clinician-based screening.5,8,9
Strengths and Limitations
This study has several strengths. First, it included a relatively large sample of women who had actually performed HPV self-sampling, allowing acceptability, usability, confidence, and future screening preferences to be evaluated on the basis of direct experience rather than hypothetical attitudes. The interviews were conducted immediately after completion of the self-sampling procedure and clinical examination during the same visit, thereby minimizing the time between the experience and its evaluation. In addition, the study provides real-world evidence from Türkiye, where HPV self-sampling is not currently incorporated as a routine component of the national cervical cancer screening program.
Several limitations should also be acknowledged. First, the cross-sectional design precludes conclusions regarding causality and does not allow determination of whether the reported preferences will translate into actual screening behavior in subsequent screening rounds. Second, the study was conducted at a single tertiary care center and included women who voluntarily accepted and completed HPV self-sampling; therefore, selection and non-response bias cannot be excluded, and the findings may not be generalizable to all screening-eligible women, particularly those who decline self-sampling or do not attend healthcare services. Third, although the questionnaire was translated and culturally adapted for the Turkish population, formal psychometric validation was not performed. Fourth, the findings were based on self-reported responses and may therefore be affected by social desirability or response bias. Finally, although all candidate variables were initially considered in the multivariable analysis, the final regression model had modest explanatory power (Nagelkerke R2=0.093), indicating that potentially important determinants of screening preference were not captured. Factors such as health literacy, perceived test accuracy, trust in self-collected samples and healthcare professionals, and other psychosocial or behavioral characteristics were not directly measured and should be investigated in future studies. Multicenter and longitudinal studies including more diverse populations are needed to assess the generalizability of these findings and determine whether stated preferences after self-sampling predict subsequent screening behavior.
Conclusion
HPV self-sampling was highly acceptable and well tolerated among women with actual prior self-sampling experience. Nevertheless, favorable experiences did not necessarily translate into a preference for self-sampling in future screening, as nearly half of the participants continued to prefer clinician-based screening. Educational level was significantly associated with screening preference, whereas age was not, although the modest explanatory power of the regression model suggests that additional psychosocial and behavioral factors may contribute to women’s preferences. These findings support HPV self-sampling as a potentially valuable complementary option within organized cervical cancer screening programs rather than as a universal replacement for clinician-based screening. Implementation strategies should preserve patient choice and provide clear information regarding sample collection and test reliability, with appropriate professional support when needed. As the findings were derived from women who voluntarily accepted and completed self-sampling at a single center, further multicenter and longitudinal studies are needed to determine their generalizability and whether favorable experiences translate into sustained use of self-sampling in subsequent screening rounds.
Funding Statement
The author received no specific funding for this study.
Abbreviations
HPV, human papillomavirus; KETEM, Cancer Early Diagnosis, Screening and Training Center; OR, odds ratio; CI, confidence interval; SD, standard deviation.
Data Sharing Statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Ethical Considerations
This study was conducted in accordance with the Declaration of Helsinki. Ethical approval for the present study was obtained from the Health Sciences Scientific Research Ethics Committee of Kırşehir Ahi Evran University (Approval No: 2025-20/264; Date: 23 December 2025). Written informed consent was obtained from all participants prior to study participation.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The author reports no conflicts of interest in this work.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.