Reactions of women underscreened for cervical cancer who received unsolicited human papillomavirus self-sampling kits

Colin Malone, Jasmin A. Tiro, Diana S.M. Buist, Tara Beatty, John Lin, Kilian Kimbel, Hongyuan Gao, Chris Thayer, Diana L. Miglioretti, Rachel L. Winer

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objectives: To evaluate experiences and reactions after receiving a mailed, unsolicited human papillomavirus self-sampling kit and identify psychosocial correlates of using kits. Methods: Survey participants were underscreened women aged 30–64 who were mailed human papillomavirus kits as part of a pragmatic trial at Kaiser Permanente Washington, a United States integrated health care system. Six months after the mailing, we invited kit returners and non-returners to complete a web survey that measured psychosocial factors (e.g. cervical cancer/human papillomavirus knowledge, attitudes toward screening), experiences, and reactions to kits. We compared responses between kit returners and non-returners. Results: Comparing 116 kit returners (272 invited) and 119 non-returners (1083 invited), we found no clinically significant differences in psychosocial factors. Overall, survey respondents showed knowledge gaps in human papillomavirus natural history (82% did not know human papillomavirus infection can clear on its own) and interpreting human papillomavirus test results (37% did not know a human papillomavirus-negative result indicates low cancer risk). Kit returners found kits convenient and easy to use (>90%). The most common reason for non-return was low confidence in ability to correctly use a kit, although many non-returners (49%) indicated that they would consider future use. Women reported low trust in human papillomavirus testing to identify women at high risk for cervical cancer (52% in returners, 42% in non-returners). Conclusions: Screening programs could improve uptake and acceptability of human papillomavirus self-sampling through outreach materials that emphasize the high efficacy of human papillomavirus testing for cervical cancer screening and educate patients about how to interpret results.

Original languageEnglish (US)
JournalJournal of Medical Screening
StateAccepted/In press - 2019


  • Human papillomavirus DNA tests
  • cervical cancer screening
  • early detection of cancer
  • embedded research
  • pragmatic randomized trial
  • surveys and questionnaires

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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