Self-sampling is a reliable and acceptable screening approach in hard-to-reach women and low-resource settings (1). ACCESSING (Adequate Cervical cancer Capacity building, Education and Screening by new Scientific Instruments in Ghana) is a feasibility study for self-sampling in rural communities of the North Tongu district in Ghana. In order to acquaint female health care workers with the sampling method, female employees were invited to self-collect a cervicovaginal lavage (DELPHI Screener™) and were interviewed to explore acceptability and their potential role as screening advocates.
A mixed methods approach was used to evaluate the acceptability of self-sampling among female health care providers working in a district hospital. Ethical clearance and written informed consent was obtained for sampling and interviews. 52 staff members who had self-collected a sample filled in questionnaires. A qualitative study obtained in-depth information on opinion, preference and implications of participating in the self-sampling workplace program. Ten participants were purposively sampled and interviewed. Interviews were analyzed according to qualitative content analysis guidelines.
The quantitative analysis of the questionnaires (n=52, average age: 36 years, SD 10.6, range 23 to 59) showed that ~96% (50/52) took the sample themselves and ~2% (1/52) had the sample taken by a fellow health worker at the clinic (1/52 n.a.). Of the ones that took the sample themselves 100% (50/50) found it “Easy” (9) or “Very Easy” (41). ~92% (46/50) felt “Very Comfortable” and ~8% “Comfortable”. ~83% (43/52) indicated that they would get checked more often if the Delphi Screener works as well as going to see a doctor at a clinic to get sampled. ~ 98% (51/52) indicated they would prefer self-sampling if their risk is as reliably determined as by physician-directed cytobrush sampling.
All interview participants (n=10, average age: 40.9 years, SD 10.8, range 28 to 59) indicated that they appreciate the program and recommend to their patients and/or family members and neighbours to get screened for cervical cancer. Common reasons for preferring self-sampling were less (anticipated) pain compared to speculum examination and more privacy.
Self-sampling for cervical cancer screening is highly acceptable to female healthcare providers who took a sample themselves. Setting up a workplace program that entails the possibility of self-sampling can help to ensure effective cervical cancer screening and at the same time creates awareness among healthcare providers to educate their patients as well as families and neighbours on cervical cancer and advocate for women’s participation in screening.
((1) Arbyn M et al., Lancet Oncol. 2014 ;15(2):172-83)