Self-collection for vaginal human papillomavirus testing: systematic review of studies asking women their perceptions.

OBJECTIVES: To systematically review literature on women's acceptance, preference, willingness, and attitudes toward human papillomavirus DNA vaginal self-sampling and assess study validity using the STROBE statement.
MATERIALS AND METHODS: From September to October 2008, Ovid MEDLINE, EMBASE, and CINAHL databases were searched systematically over all years available. Participants were women who either completed vaginal self-sampling or were described the procedure. Studies were required to report women's acceptance, preference, willingness or attitudes toward self-sampling. Two independent reviewers assessed abstracts and articles for inclusion and collected study data. Disagreements were resolved by consensus.
RESULTS: Twenty studies were included. Of 8 studies, 7 reported that women found self-sampling acceptable. Of the 13 studies, 8 found that more women (63%-94%) preferred self-sampling to clinician-collected sampling. Most women were also receptive to self-sampling as part of future screening. Common opinions expressed by women included an uncertainty if they had or could perform the self-test properly and greater confidence in clinician sampling. Only 2 studies used questionnaires that had been validated, and selection bias favoring self-sampling could not be ruled out in most studies.
CONCLUSIONS: Vaginal human papillomavirus DNA self-sampling is generally well received among women. However, the possibility of selection bias and survey instrument measurement error may have led to an overestimate of women's favorable opinions for self-sampling. A self-sampling option may increase screening coverage, but concerns of women must also be addressed.