Cervical Cancer Screening in Women With Physical Disabilities.

Abstract

Importance: Cervical cancer screening is a crucial public health intervention, but screening disparities exist for women with physical disabilities (WWPD).

Objective: To explore the experiences of WWPD with both traditional speculum examination-based screening and at-home self-sampling for cervical cancer screening.

Design, setting, and participants: This qualitative study enrolled 56 WWPD to test self-sampling kits, provide feedback via a survey, and participate in a qualitative interview. An interprofessional team conducted semistructured interviews with 16 key informants and 40 pilot participants for 56 WWPD from November 1, 2021, through April 30, 2023. All completed a self-administered quantitative survey. Key informants' experiences with 4 self-sampling devices helped determine which 2 self-sampling kits would be offered to participants in a pilot study.

Main outcomes and measures: A coding scheme was developed to represent inductive codes generated through preliminary coding and deductive codes representing domains from the Theoretical Domains Framework. This coding scheme was used to conduct a 2-pass thematic analysis.

Results: Of the 56 WWPD (mean [SD] age, 45.4 [9.1] years) who participated in the study, 28 (50.0%) were up to date with cervical cancer screening. Participants described accessibility barriers and clinician ableism that made speculum-based in-office examinations difficult, leading some participants to delay or avoid screening. In contrast, participants described self-screening as more comfortable and convenient, regardless of whether they prefer future speculum-based screening. Their responses also allowed for the exploration of how screening preferences may impact future screening behavior.

Conclusions and relevance: Interviews with WWPD suggested that access to self-sampling screening options would be more comfortable for cervical cancer screening participation. Understanding participants' experiences with self-sampling devices generates insights into improving screening experiences for WWPD.