Determinants for participation in human papillomavirus self-sampling among non-attenders to cervical cancer screening in Denmark

BACKGROUND: Offering human papillomavirus-based self-sampling to non-participants in routine cervical cancer screening can increase screening participation. However, little is known about characteristics of women who accept self-sampling. In this population-based study, we investigated determinants for participation in self-sampling among Danish non-attenders to routine cervical cancer screening.

METHODS: During 2014-2015, a random sample of screening non-participants aged 27-65 years living in the Capital Region of Denmark were invited for self-sampling. Of 21,314 eligible women, 4,743 participated in self-sampling. Information on sociodemographic characteristics and mental and physical health of all the women was obtained from nationwide registries, and 3,707 women completed a questionnaire on lifestyle, sexual behavior and reasons for non-participation in routine screening. We used logistic regression to estimate odds ratios (ORs) for participation in self-sampling, crude and adjusted for sociodemographic characteristics.

RESULTS: Basic education (ORadjusted=0.79, 95% CI 0.72-0.88); low income (ORadjusted=0.66, 95% CI 0.59-0.73); origin from a non-western country (ORadjusted=0.43, 95% CI 0.38-0.48) and being unmarried (ORadjusted=0.66, 95% CI 0.61-0.72) were associated with lower self-sampling participation. Long-term unscreened women (ORadjusted=0.49, 95% CI 0.45-0.53); women with prior schizophrenia or other psychoses (ORadjusted=0.62, 95% CI 0.48-0.80); women with poor self-perceived health (ORadjusted=0.42, 95% CI 0.25-0.69); and women who perceived screening as unnecessary (ORadjusted=0.54, 95% CI 0.37-0.80) or irrelevant (ORadjusted=0.81, 95% CI 0.78-0.96) were less likely to self-sample.

CONCLUSIONS: Certain population groups, including women with low socioeconomic position or of non-western origin, were less likely to participate in self-sampling.

IMPACT: Targeted approaches may be needed to increase screening participation in these groups.