Abstract:
Background: In the context of WHO’s “task shifting” project and growing global consensus on primary HPV-based
cervical cancer screening, self-sampling is a promising new tool to expand screening access, uptake and coverage
for women worldwide. We aimed to explore perceptions and acceptability of HPV self-sampling-based
cervical cancer screening among community members and health professionals in rural northwest Ethiopia
and to identify preferences and socio-cultural barriers regarding self-sampling in order to design a suitable
high-coverage screening intervention for a rural African setting.
Methods: Four community-based focus group discussions (FGD) were conducted in the rural district of
Dabat, Northwest Ethiopia, each comprising 8 to 14 female participants, counting a total of 41 participants.
The groups were homogenously composed in terms of their socio-economic status in the community. They
included health centre attendees, community members, nurses and health development army leaders (HDAL). Two
qualitative data collection experts conducted the interviews in the local language, using a FGD guide with several
thematic areas. All participants granted written informed consent prior to the conduct of the interviews. As a concrete
example of an existing self-sampling approach for cervical cancer screening we used the Evalyn® Brush.
Results: Emerging themes included (i) misconceptions and low awareness about cervical cancer among community
residents and primary health care providers in rural northwest Ethiopia, (ii) stigmatization and social exclusion of
affected women, (iii) delay in seeking of health care due to poor access and availability of services, and lacking of a
concept of early cancer prevention, (iv) need of spousal permission, (v) fear of financial burden and (vi) fear of social
marginalization. The self-sampling device was regarded to be acceptable and was judged to be easy to use for most
women. The existing Ethiopian health care structure could facilitate a community approach.
Conclusion: Home-based self-sampling for cervical cancer screening is a socially acceptable and feasible “task shifting”
method that will increase cervical cancer screening access and coverage in the Ethiopian study community. Education,
awareness creation, community mobilization and family inclusion are identified as key activities to promote, implement
and facilitate “task shifting” approaches like self-sampling.
