Testing positive for Human Papillomavirus (HPV) at primary HPV cervical screening: A qualitative exploration of women’s information needs and preferences for communication of results

Sophie Mulcahy Symmons,Jo Waller,Emily Mcbride

doi:10.1016/j.pmedr.2021.101529

Abstract

Human Papillomavirus (HPV) primary cervical screening was implemented across England during 2019, where cervical cell samples are first tested for HPV and cytology is used to triage HPV-positive results. Around 8.5% of women who attend test HPV-positive with normal cytology (HPV+/normal). We aimed to explore women’s information needs and suggestions for improvements to result communication following an HPV+/normal result, among those with higher and lower levels of education. In‐depth interviews were conducted with 30 women aged 24–63 who had tested HPV+/normal at routine screening. Secondary qualitative data, not previously reported, were analysed using Framework Analysis to compare themes between those with education lower-than-degree-level vs. degree-level-or-higher (n = 15 in each group). Regardless of education level, women had unanswered questions about their result meaning and the HPV primary screening protocol. Expectations of cervical screening did not always match the service provided, especially regarding content of letters and mode of result delivery. Women with lower education were less clear about the meaning of normal cytology and its link to HPV; and had difficulty sourcing information after their result. Pragmatic suggestions were made for preferences in content, wording, format, and delivery of information in patient communications. Overall, our findings point to areas which can be used by policymakers and healthcare professionals to inform content and communication of results, as HPV primary screening continues to be implemented and refined worldwide. Future research should use these suggestions to develop patient materials and then test them to assess content engagement and information recall.

Highlights

Human Papillomavirus (HPV) is a sexually transmitted infection responsible for most cervical cancers (Jemal et al, 2010)
In England, the National Health Service Cervical Screening Programme (NHSCSP) recently implemented routine HPV primary screening, where cervical cell samples are first tested for HPV and cytology is used to triage HPV-positive results, which is comparable to other HPV primary programmes internationally (Anttila et al, 2015; World Health Organisation, 2013; Huh et al, 2015)
Around 8.5% of women are expected to test positive for HPV with normal cytology (HPV+/normal) each year; a result which is specific to the HPV primary screening algorithm, carrying a low absolute cancer risk (Rebolj et al, 2019)

Summary

Introduction

Human Papillomavirus (HPV) is a sexually transmitted infection responsible for most cervical cancers (Jemal et al, 2010). Around 8 in 10 women are infected with HPV at least once in their lifetime (Chesson et al, 2014). HPV primary screening is predicted to prevent up to 563 cervical cancers each year in the United Kingdom (Castanon et al, 2017). Under HPV primary screening in England, women are invited to be screened every 3 or 5 years, depending on age. Around 8.5% of women are expected to test positive for HPV with normal cytology (HPV+/normal) each year; a result which is specific to the HPV primary screening algorithm, carrying a low absolute cancer risk (Rebolj et al, 2019). Women who test HPV+/ normal are recalled early to screening at 12 months to test for persistent HPV infection; and can receive this result three consecutive times before referral to colposcopy (Public Health England, 2017)

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