Exploring Emotional and Cognitive Perceptions of Cervical Cancer Screening and Self-Sampling Among Vulnerable Romanian Women: A Qualitative Study

INTRODUCTION: This study aimed to explore the emotional and cognitive perceptions of cervical cancer screening (CCS), with a focus on self-sampling for human papillomavirus (HPV) by vulnerable Romanian women.

METHODOLOGY: Eighteen semi-structured individual interviews were conducted with vulnerable women, defined by their low socioeconomic status (SES), residence in rural areas and membership in ethnic minorities. Participants were recruited using snowball sampling. Interviews followed a guide designed to assess constructs from the Health Belief Model (knowledge, barriers, evaluation of vulnerability) as they relate to women's views of prevention, the healthcare system and CCS. A Think Aloud protocol was used with a subsample of six women to identify potential barriers, opportunities and attitudes related to the use of self-sampling kits. A reflexive thematic analysis was conducted to identify the primary themes related to with women's perceptions of CCS and self-sampling.

RESULTS: Four major themes emerged: (a) risk, fear and other emotional experiences; (b) women's perception of barriers; (c) knowledge, personal control and cues to action; and (d) women's perception of self-sampling. Participants unravelled emotional and logistical barriers to CCS and self-sampling. Limited health literacy, fear and shame influenced risk perceptions, hindering CCS participation. Logistical challenges and financial constraints further impeded access, while women often prioritized the needs of their families over their own health. The Think Aloud protocol revealed that initial concerns regarding self-sampling could be alleviated by having clear instructions, highlighting the importance of support during the decision-making process.

CONCLUSION: This study identified diverse barriers preventing vulnerable Romanian women from engaging in CCS, including logistical challenges, financial constraints and emotional factors.

PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in the design, conduct, analysis or interpretation of the study.