| Description |
Background: Human papillomavirus (HPV) is the primary cause of cervical cancer, which remains a significant public health concern, especially in low-resource settings and underserved populations. Barriers to traditional screening include discomfort, lack of access, financial constraints, and patient-provider relationships, leading to low screening rates. HPV self-collection is as accurate as clinician-collected samples for detecting high-risk HPV types. Local Problem: In rural Utah, community health centers have seen a trending decline in cervical cancer screening rates, as reported in Uniform Data System (UDS) reports. Limited access to healthcare, long travel distances, provider shortages, and economic constraints make it difficult for many women to receive regular cervical cancer screenings. Additionally, there may be a lack of awareness about the importance of screening, cultural stigma around pelvic exams, and concerns about privacy in close-knit communities. These factors result in under-screening and late-stage cancer diagnoses. Introducing HPV self-collection in local clinics or community settings would offer a convenient, private, and less invasive option, helping to overcome these barriers. The purpose of this project is to improve health outcomes and reduce the incidence of cervical cancer in our rural community. Methods: This quality improvement project was implemented in two rural community health centers in Utah to evaluate the feasibility, usability, and effectiveness of HPV self-collection. The intervention included staff training, workflow development, and patient education on self collection methods. Screening rates before and after implementation were assessed, and staff feedback was collected to gauge satisfaction and feasibility. Interventions: The project was structured into four phases. Phase one consisted of assessment and planning that evaluated current workflows and barriers, engaged key stakeholders, and obtained staff feedback to assess the needs of the clinics. Phase two aimed at developing training for staff, workflow, kits, and patient education materials. Phase three of this project consisted of staff training and the implementation of HPV self-collection in the clinics. The Plan-Do-Study-Act (PDSA) cycle was used to make rapid cycle changes in workflow for improvement. Patients were identified using recall lists. Three screening options were offered during this phase, including two self-collection options. The fourth phase was to evaluate the project outcomes. Post implementation and pre-implementation rates were compared. Staff surveys were conducted to assess the HPV self-collection process's feasibility, usability, and staff satisfaction. Results: Before the implementation, only 36% of eligible women aged 25-65 were current with screening recommendations. Over the four-month project period, the overall cervical screening rate increased to 39.5%, representing a 3% increase, with HPV self-collection contributing to more than half of this improvement. Additionally, surveys showed that the method of HPV self-collection had a high feasibility, usability, and staff satisfaction rate among staff. Conclusion: HPV self-collection is a feasible solution for increasing cervical cancer screening rates in rural populations. The intervention was well-received by patients and healthcare providers and demonstrated potential for broader implementation. Future projects should explore long-term sustainability, patient adherence, and integration with other preventive health services to ensure equitable access to cervical cancer screening for underserved communities. |
