Perspectives from Healthcare Providers and Women about Completing Human Papillomavirus (HPV) Self-Testing at Home

Purpose: Cervical cancer (CC) incidence and mortality rates are increased and CC screening rates are low among women living in Ohio Appalachia. Mailing human papillomavirus (HPV) self-tests to women to complete at home is a potential new strategy in the United States to engage women in the CC screening process. Our study sought to understand both providers' and women's perspectives on an HPV self-test that could be mailed to women and how those viewpoints may differ and/or concur. Methods: Focus groups were conducted (2014–2015) among: 1) healthcare providers practicing in four Federally Qualified Health Centers (FQHCs) located in three Ohio Appalachia counties; and 2) women living in Ohio Appalachia. Results: Providers (n = 28) and women (n = 15) were accepting of HPV self-testing, however, the reason for acceptance differed between groups. Providers thought HPV self-testing would increase the possibility that under-screened women would return to the healthcare system, while women thought completing HPV self-tests at home would eliminate logistical/psychological CC screening barriers. Facilitators of completing an HPV self-test at home reported by women included decreased embarrassment, and the time and money saved by avoiding a doctor's appointment. Barriers to completing an HPV self-test at home reported by providers and women included women not being aware of the test, concerns about incorrectly completing the test and potential contamination of the obtained specimen, potential discomfort associated with completing the test, safety of the sample when returning it through the mail, issues associated with communicating test results (timing, channel, findings), and needed follow-up care. Both providers and women stressed the importance of including educational information about HPV and cervical cancer and detailed HPV self-test instructions with the mailed device. Conclusions: Findings provide insights into the facilitators and barriers of completing an HPV self-test at home, returning it, reporting results, and providing needed follow-up care. This information will be useful in developing CC screening programs that include mailed HPV self-tests.