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Gynecol Oncol. 2014 Mar;132 Suppl 1:S21-5. doi: 10.1016/j.ygyno.2013.10.008. Epub 2013 Oct 11.

Self-collecting a cervico-vaginal specimen for cervical cancer screening: an exploratory study of acceptability among medically underserved women in rural Appalachia.

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Department of Health Behavior, University of Kentucky College of Public Health, Lexington, KY, USA. Electronic address:
University of Kentucky Rural Cancer Prevention Center, Hazard, KY, USA.
Department of Health Behavior, University of Kentucky College of Public Health, Lexington, KY, USA.
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.



Innovative screening methods such as self-testing for human papillomavirus (HPV) may alleviate barriers to cervical cancer screening. The purpose of this exploratory study was to determine whether Appalachian Kentucky women would be amenable to self-collecting a cervico-vaginal specimen for HPV testing.


Women aged 30-64 who were overdue for guideline-recommended cervical cancer screening were recruited from a primary care clinic in southeastern Kentucky. The women were asked to self-collect a specimen, using a cervico-vaginal brush, based on verbal and printed directions provided by a research nurse. All study participants, regardless of laboratory-confirmed HPV status, received the same counseling on the importance of cervical cancer screening and offered navigation to follow-up Pap testing at the local health department.


Thirty-one women were approached and recruited to participate in the study, indicating a 100% acceptance rate of HPV self-testing. Of the 31 women, 26 tested negative for high-risk HPV and five tested positive. All of the women with negative results declined nurse navigation to Pap testing, whereas four of the five women with positive results accepted nurse navigation and received subsequent Pap smear screenings (all results were normal).


Among this sample of Appalachian Kentucky women, self-collecting a cervico-vaginal specimen for HPV testing was highly acceptable. This exploratory study provides impetus for larger studies among high-risk, medically underserved women in rural communities. Tailoring alternative cancer screening strategies to meet the complex needs of rural women is likely to lead to reductions in cervical cancer incidence and mortality among this vulnerable population.


Acceptance; Appalachia; Cervical cancer; HPV testing; Patient navigation

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