Correlates of Self-Sampling Willingness for HPV-DNA Testing among Medically Underserved Rural Kenyan Women: A Mixed Methods Study
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Introduction
Cervical cancer is the leading cause of cancer-related deaths among Sub-Saharan African women, particularly in rural areas where screening rates are lower due to limited access to highly sensitive tests. This study aimed to investigate factors that might influence rural Kenyan women’s willingness to self-collect samples for HPV-DNA testing.
Methods
This study utilized data from a mixed-methods study in Bomet and Kericho Counties, including survey responses from 174 women and semi-structured interviews with a subset of 21 participants. Logistic regression was used to analyze quantitative data and theoretical thematic analysis for qualitative data.
Results
The surveyed women had a mean age of 45.2 years, were mainly uninsured (76%) and from low-income households (88.4%). Most participants had heard of cervical cancer (83.2%), yet only 6.4% had ever been screened. However, 76.9% expressed willingness to self-collect samples for HPV-DNA testing. Factors significantly associated with increased self-sampling willingness were cervical cancer awareness (OR=3.49, 95% CI=1.50-8.11), having health workers (OR=1.88, CI=1.23-2.86) and the news media (radio and television) (OR=2.63, CI=1.27-5.48) as primary sources of health information, and ever hearing about cervical cancer from the news media (OR=2.43, CI=1.07-5.51). Conversely, high cervical cancer stigma (OR=0.71, CI=0.57-0.88) and longer travel time of 30 to 120 minutes to the nearest health facility (OR=0.44, CI=0.20-0.93) were associated with decreased willingness. Interview data corroborated these findings.
Conclusions
Cervical cancer screening uptake is notably low among rural Kenyan women in Bomet and Kericho Counties. Sample self-collection for HPV-DNA testing appears widely acceptable. A comprehensive approach involving educational outreach, health worker recommendation, and mass media campaigns could enhance cervical cancer screening via self- sampling, potentially reducing the burden of cervical cancer. Future research should employ implementation science methodologies to explore cervical cancer screening uptake via self- sampling, to inform population-based implementation strategies in Kenya.
