# Women’s Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening

## TL;DR

The study finds that 20% of US women prefer home-based cervical cancer screening, with marginalized groups more likely to prefer this option due to privacy and trust issues.

## Contribution

The study provides nationally representative data on women's preferences for home-based cervical cancer screening and identifies demographic and experiential factors influencing these preferences.

## Key findings

- Non-Hispanic Black women had lower odds of preferring home-based self-sampling compared to non-Hispanic White women.
- Women who experienced discrimination in medical settings had higher odds of preferring home-based self-sampling.
- Privacy concerns, time constraints, and fear of embarrassment were the top reasons for preferring home-based testing.

## Abstract

This cross-sectional study assesses whether women in the US prefer at-home self-sampling or clinic-based testing for cervical cancer screening and factors associated with this preference.

Do women prefer home-based self-sampling over clinic-based testing for cervical cancer screening, and what factors are associated with this preference?

In this population-based cross-sectional study of 2300 screening-eligible women, 20% preferred home-based self-sampling, 61% preferred clinic-based testing, and 19% were uncertain. Non-Hispanic Black compared with non-Hispanic White individuals had lower odds of preferring home-based self-sampling, while individuals who had experienced prejudice or discrimination in medical settings had higher odds.

Fewer individuals preferred home-based vs clinic-based testing, but higher odds of preferring home-based self-sampling among marginalized groups suggest that if incorporated into national guidelines, the home-based modality could increase cervical cancer screening uptake.

While home-based self-sampling for cervical cancer screening is an evidence-based strategy proven to increase screening access and uptake, it is not currently recommended in the US despite recent Food and Drug Administration approval of the first at-home self-sampling device. Little nationally representative research has examined preference for and drivers of home-based self-sampling over clinic-based testing (the standard of care).

To assess women’s perspectives about, reasons for considering, and factors associated with preferring at-home self-sampling for cervical cancer screening.

This population-based cross-sectional study used data from the 2024 Health Interview National Trends Survey (HINTS 7), a nationally representative survey of the civilian, noninstitutionalized US adult population offered between March and September 2024. Respondents included in this study were individuals aged between 21 and 65 years who were eligible for cervical cancer screening per the US Preventive Services Task Force guidelines and who self-reported their gender identity. Respondents who indicated not needing cervical cancer screening or who did not report their preference for any screening modality (home-based self-sampling or clinician-collected sampling) were excluded. Data were analyzed from May 12 to 25, 2025.

Age, race and ethnicity, income, educational level, sexual orientation, marital status, health insurance, urbanicity of residence, trust in the health care system, past-year number of visits to a health care practitioner, and prior experience of discrimination or prejudice when getting medical care.

The main outcome was preference for at-home vaginal self-sampling over clinic-based testing, measured using the HINTS 7 question, “If you had choice, how would you prefer to do the cervical cancer screening test?” Responses were: preference to have a health care practitioner do the test in his or her office, preference to self-collect specimen for the test at home, not knowing which option to choose, and not applicable. Weights were assigned to improve representativeness of the general US adult population. The proportion of individuals who reported preferring either screening modality was estimated using weighted percentages. Survey-weighted odds ratios (ORs), adjusted for covariates, were calculated to identify factors associated with preference for at-home self-sampling.

Among the 2300 women included (mean [SD] age, 45.5 [29.2] years), most were married or living as married (weighted percentage, 58.2% [95% CI, 56.5%-60.0%]), health insured (91.9%; 95% CI, 90.7%-93.1%), and educated up to some college (61.6%; 95% CI, 60.1%-63.0%). Overall, 462 (20.4%; 95% CI, 17.4%-23.4%) preferred at-home self-sampling, 1402 (60.8%; 95% CI, 57.2%-64.4%) preferred clinic-based testing, and 436 (18.8%; 95% CI, 15.5%-22.1%) were uncertain about their choice. Non-Hispanic Black respondents (adjusted OR [AOR], 0.45; 95% CI, 0.21-0.96) had lower odds of preferring at-home self-sampling compared with non-Hispanic White individuals. Women who had experienced prejudice or discrimination when getting medical care had higher odds (AOR, 1.94; 95% CI, 1.16-3.22) of preferring at-home self-sampling. The most commonly self-reported reasons for preferring at-home self-sampling were privacy (54.9%; 95% CI, 49.8%-60.0%), time constraints (35.1%; 95% CI, 29.0%-41.2%), and fear of embarrassment (33.4%; 95% CI, 28.0%-38.8%).

In this cross-sectional study, marginalized populations, individuals with low income, and individuals who do not trust the health care system were more likely to prefer at-home self-sampling for cervical cancer screening or not know which option to choose. To address cervical cancer inequities and increase screening uptake, the findings suggest US guidelines should incorporate home-based self-sampling as an alternative to clinic-based testing, women’s education and empowerment should be enhanced, and tailored interventions focusing on high-risk groups are needed to increase awareness and self-confidence in performing home-based self-sampling.