On the path toward cervical cancer elimination in Canada: a national survey of factors influencing women's intentions to participate in human papillomavirus test-based primary cervical screening

Ovidiu Tatar; Ben Haward; Samara Perez; Patricia Zhu; Julia Brotherton; Kathleen Decker; Aisha K Lofters; Marie-Hélène Mayrand; Emily McBride; Gina Ogilvie; Gilla K Shapiro; Laurie W Smith; Marc Steben; Jo Waller; Gregory D Zimet; Zeev Rosberger

doi:10.1016/j.lana.2024.100901

On the path toward cervical cancer elimination in Canada: a national survey of factors influencing women's intentions to participate in human papillomavirus test-based primary cervical screening

Lancet Reg Health Am. 2024 Oct 15:39:100901. doi: 10.1016/j.lana.2024.100901. eCollection 2024 Nov.

Authors

Ovidiu Tatar^{1

2}, Ben Haward^{1

3

4}, Samara Perez^{5

6

7

8}, Patricia Zhu¹, Julia Brotherton⁹, Kathleen Decker^{10

11}, Aisha K Lofters^{12

13}, Marie-Hélène Mayrand^{2

14}, Emily McBride¹⁵, Gina Ogilvie^{16

17

18}, Gilla K Shapiro¹⁹, Laurie W Smith^{16

17}, Marc Steben^{7

20}, Jo Waller²¹, Gregory D Zimet²², Zeev Rosberger^{1

6

7

23

6

24}

Affiliations

¹ Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada.
² Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
³ Harvard Law School, Harvard University, Cambridge, MA, United States.
⁴ Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, United States.
⁵ Psychosocial Oncology Program, Division of Supportive and Palliative Care, Cedars Cancer Centre, McGill University Health Centre, Montreal, QC, Canada.
⁶ Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada.
⁷ HPV Global Action, Montreal, QC, Canada.
⁸ Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
⁹ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
¹⁰ Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹¹ Paul Albrechtsen Research Institute Cancer Care Manitoba, Winnipeg, MB, Canada.
¹² Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
¹³ Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada.
¹⁴ Département d'obstétrique-gynécologie, Université de Montreal, Montreal, QC, Canada.
¹⁵ Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom.
¹⁶ BC Centre for Disease Control, Vancouver, BC, Canada.
¹⁷ Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
¹⁸ Women's Health Research Institute, Vancouver, BC, Canada.
¹⁹ Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
²⁰ School of Public Health, Université de Montréal, Montreal, QC, Canada.
²¹ Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
²² Emeritus School of Medicine, Indiana University, Indianapolis, IN, United States.
²³ Department of Psychiatry, McGill University, Montreal, QC, Canada.
²⁴ Department of Psychology, McGill University, Montreal, QC, Canada.

Abstract

Background: HPV test-based primary cervical screening is replacing cytology in Canada. In other countries, women's unpreparedness and concerns hindered the transition and post-implementation screening uptake. We investigated psychosocial correlates of intentions of screening in eligible individuals to participate in HPV-based primary cervical screening.

Methods: We conducted a nationwide web-based survey of individuals aged 21-70 years in 2022 and oversampled under-screened individuals. We used five Canadian-validated scales to measure HPV test-based screening knowledge, attitudes, and beliefs. Using the multistage Precaution Adoption Process Model, we assessed women's stage of intentions to participate in HPV testing and self-sampling. We estimated associations of psychosocial factors with intentions' stage using multinomial logistic regression.

Findings: In both groups (adequately screened n = 1778; under-screened n = 1570), higher HPV knowledge was associated with intention for HPV testing and more personal barriers to the HPV test were associated with lower intentions to participate in HPV testing or use of self-sampling. In both groups, higher self-sampling concerns were associated with lower intentions for self-sampling and higher women's need for autonomy was associated with increased intentions for self-sampling. In the under-screened group, increased age was associated with lower intentions for HPV testing and self-sampling, while living in Canada for <10 years was associated with higher intentions.

Interpretation: Our results could be used by policymakers and healthcare professionals to design communication strategies and ensure a smooth transition to HPV-based primary cervical screening, especially for under-screened individuals.

Funding: Canadian Institutes of Health Research project grant 165905.

Keywords: Attitudes and beliefs; Behavioural sciences; Cancer prevention; Cervical screening; HPV testing; Human papillomavirus; Obstetrics and gynecology; Public health; Reproductive health; Screening intentions; Self-sampling; Women's health.