Abstract
Objectives
Immigrant and low socio-economic (SES) women in North America underutilize Papanicolaou screening. Vaginal swab self-sampling for oncogenic human papillomavirus (HPV) has the potential to increase cervical cancer screening participation. The purpose of this qualitative study was to understand the perceptions of lower SES and immigrant women regarding self-sampling for HPV.
Methods
Eleven focus-group interviews were conducted: one with Canadian-born English-speaking lower SES women, and two groups each with Arabic, Cantonese, Dari (Afghani), Somali and Spanish (Latino)-speaking women (one group conducted in English, the other in the native language) recently immigrated to Canada. Five to nine women aged 35 to 65 years and married with children participated in each group.
Results
Themes included 1) who might use self-sampling and why; 2) aversion to self-sampling and reasons to prefer physician; 3) ways to improve the appeal of self-sampling. Women generally perceived benefits of self-sampling and a small number felt they might use the method, but all groups had some reservations. Reasons included: uncertainty over performing the sampling correctly; fear of hurting themselves; concern about obtaining appropriate material; and concerns about test accuracy. Women preferred testing by a health care professional because they were accustomed to pelvic examinations, it was more convenient, or they trusted the results.
Conclusions
Perceptions of self-sampling for HPV were similar across cultures and pertained to issues of confidence in self-sampling and need for physician involvement in care. These findings can inform programs and studies planning to employ self-sampling as a screening modality for cervical cancer.
Key words: Emigrants and immigrants; mass screening; human papillomavirus; qualitative research
Résumé
Objectifs
Les immigrantes et les femmes de faible statut socioéconomique (SSE) en Amérique du Nord sous-utilisent le dépistage par frottis de Papanicolaou. L’autoprélèvement vaginal pour détecter le virus du papillome humain (VPH) oncogène pourrait accroître la participation au dépistage du cancer du col utérin. Notre étude qualitative visait à connaître les perceptions des femmes de faible SSE et des immigrantes sur l’autoprélèvement pour dépister le VPH.
Méthode
Nous avons mené 11 entretiens en profondeur auprès de différents groupes: un premier composé de femmes anglophones de faible SSE nées au Canada et deux groupes composés de femmes récemment immigrées au Canada; l’un de ces groupes a eu lieu en anglais et l’autre dans la langue maternelle des femmes, soit l’arabe, le cantonais, le dari (l’afghan), le somali et l’espagnol (latinophones). Chaque groupe comptait entre cinq et neuf femmes de 35 à 65 ans mariées et mères de famille.
Résultats
Nous avons abordé les thèmes suivants: 1) qui est susceptible d’utiliser l’autoprélèvement et pourquoi; 2) l’aversion à l’autoprélèvement et les raisons pour lesquelles on préfère qu’un médecin s’en charge; et 3) les moyens d’améliorer l’attrait de l’autoprélèvement. Les femmes percevaient en général les avantages de l’autoprélèvement, et un petit nombre d’entre elles sentaient qu’elles pourraient y avoir recours, mais tous les groupes ont exprimé des réserves. Raisons évoquées: la crainte de ne pas prélever correctement l’échantillon; la peur de se faire mal; la difficulté possible de se procurer le matériel nécessaire; et les craintes quant à l’exactitude du test. Si les femmes préfèrent se faire tester par un professionnel de la santé, c’est parce qu’elles sont habituées aux examens pelviens, qu’elles les trouvent plus pratiques ou qu’elles ont plus confiance en leurs résultats.
Conclusion
Les perceptions interculturelles de l’autoprélèvement pour dépister le VPH sont semblables; elles ont trait au manque de confiance en l’autoprélèvement et au besoin d’une intervention du médecin dans les soins. Ces constatations pourraient étayer la planification de programmes et d’études portant sur l’autoprélèvement comme méthode de dépistage du cancer du col utérin.
Mots clés: émigrantes et immigrantes, dépistage de masse, virus du papillome humain, recherche qualitative
Footnotes
Acknowledgements: This research was supported by the Canadian Cancer Etiology Research Network (CCERN) and the City of Hamilton Public Health and Social Services via the Public Health Research Education and Development Program (PHRED).
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