Moroccan and Pakistani women's knowledge and perceptions on cervical cancer screening and HPV self-sampling acceptability in Catalonia, Spain: a mixed-methods study.

BACKGROUND: Disparities in cervical cancer (CC) screening participation persist, with lower rates among immigrant women from low-resource countries compared to native European women. Evidence-based strategies to reach under-screened women are thus needed, such as adopting self-sampling for human papillomavirus (HPV) testing. Studies have demonstrated that women are receptive to HPV self-sampling. However, results may not be generalizable to all ethnic groups and settings. This is the first study in Spain assessing HPV self-sampling acceptability among immigrant populations. A mixed-methods study was used to explore knowledge and perceptions of CC screening and attitudes towards HPV self-sampling among Moroccan and Pakistani women in Catalonia. METHODS: Eight focus group discussions and twenty-two semi-structured interviews were conducted. After a short demonstration of two self-sampling devices, women were invited to try them at home and complete an acceptability survey for each device, including questions assessing screening preferences, perceived self-efficacy, trust in the test results and willingness to use the self-collection method again. RESULTS: Important barriers, such as lack of information about CC screening, and misconceptions about HPV risk were identified. Overall, Moroccan and Pakistani women expressed a preference for clinician-based screening over self-sampling. Over half of the participants (56%) accepted to try at least one self-sampling device. However, concerns about collecting the sample correctly and distrust in the test result were raised. CONCLUSION: Increasing awareness and empowering Moroccan and Pakistani women with culturally appropriate information about the benefits of CC screening is the first step to successfully implement HPV self-sampling. Concerns regarding self-efficacy need also to be addressed before implementing new organised screening programmes using HPV self-sampling in Catalonia, Spain. A peer-based approach using culturally appropriate materials is proposed to best inform, educate, foster confidence, and advocate for the uptake of HPV self-sampling among these two groups of women.