Do it for yourself: Australia’s first experience of universal eligibility for self-collection cervical screening increases access for Aboriginal and Torres Strait Islander women

Abstract

Purpose

Australia’s National Cervical Screening Program implemented a self-collection pathway in December 2017 that was specifically designed to engage never-screened and under-screened people with a cervix. Initially only available to those under-screened, a revised policy (implemented in July 2022) now allows all women and people with a cervix the choice to participate in cervical screening through self-collection. While self-collection offers opportunities for Aboriginal Community Controlled Organisations (ACCO) to increase cervical screening participation, implementation evidence is lacking.

Methods

Semi-structured interviews were conducted with Aboriginal women (n = 7) and health service staff (n = 2) at a regional Aboriginal Community Controlled Organisation, in November to December 2019, to identify barriers and facilitators to cervical screening participation. A co-design workshop followed in mid-2020 with participants reviewing data, leading to the design and implementation of a demonstration project – Do it for yourself! – providing universal access to self-collection in the context of a consultation.

Main findings

Thirty-seven women participated in Do it for yourself! between April 2021 and March 2022. One-third would not have participated in cervical screening if self-collection had not been available. Most women (84%) were confident that they had properly collected the sample. Most women who had screened before preferred self-collection (81%), would be more likely to screen on-time if self-collection was available (95%), and all would recommend the screening pathway. Universal access to self-collection appeared to engage Aboriginal women who would otherwise not have screened.

Principal conclusions

Early implementation experience demonstrated that self-collection, offered in the context of a consultation with a cervical screening provider, is highly acceptable and facilitates the engagement of women who would otherwise not have screened.