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.

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.
Competing Interests: OT received support from the Canadian Institutes of Health Research (CIHR) through the Frederick Banting and Charles Best Doctoral award (Award No. FBD-170837) outside the scope of the submitted work. OT also serves as a part-time Research Associate Research Associate at the Lady Davis Institute for Medical Research (Montreal, Canada). GKS is supported by the Edith Kirchmann Postdoctoral Fellowship at Princess Margaret Cancer Centre and holds a CIHR 2019 fellowship award (CIHR MFE 171271) unrelated to the submitted study. GZ has received grants, contracts and consulting fees from Merck, has participated on the Data Safety Monitoring Board or Advisory Board for Merck and Moderna, and is a member of the Board of Directors of Unity Consortium, a non-profit organization. JW reports consultancy payments from Hologic to her institution for attending a cervical cancer patient advocacy workshop and participating in a discussion panel. She also received support from Hologic for travel expenses to attend patient advocacy meetings. MS has received grants and lecture honoraria from Abbott, Roche Diagnostics, Laboratories Biron and Attila Diagnostic. MS is the President of the International Society for STD Research, Co-President of the STI&HIV 2025 World Congress, and a board member of the International Papillomavirus Society. MS also reports receiving equipment from the National Cancer Institute. ZR reports unpaid leadership involvement as Vice-President of HPV Global Action, in a non-governmental organization, outside of the submitted work. LS reports consulting fees from the Canadian Partnership Against Cancer (Non-profit organization) EM, JB, KD, PZ, AL, BH, GO, SP, and MHM declare no conflicts of interest.
(© 2024 The Author(s).)