Perceptions of Self Sampling and Urine Sampling Versus Traditional Pap Smear in Rural Settings of Cuenca Ecuador

Abstract Background: Cervical cancer screening has demonstrated high effectiveness reducing cervical cancer mortality worldwide, however there is still a high rate of under screened women. Pap smear technique is often considered an uncomfortable examination technique that can reduce uptake of the examination. This study explores the perceptions of self sampling and urine sampling versus traditional pap smear in rural settings of Cuenca Ecuador.Methods A qualitative study with a phenomenological approach was performed. Focus groups were conducted in El Valle parish of Azuay province of Cuenca Ecuador. Women natives of this rural area were included in this research. Results A total of 45 women, have participated in 7 focus groups, all participants live in rural area. Pap smear technique is considered a painful, intrusive and embarrassing method, however participants believe that is more reliable, compared with self sampling methods, due a direct visualization of the cervix and because other problems could be detected during the examination. Advantages of self-sampling include that it is perceived as comfortable, less painful, participation rate, time-saving, because it can be done at home, and can be made widely available for example through pharmacies or with help of traditional healers . Barriers are related with doubts of the quality of the sample and lack of capability to perform it. Conclusions This study shows that women consider self sampling methods as a possible solution to overcome barriers that could reduce the uptake of cervical cancer screening; privacy, comfortability and accessibility are major advantages of those methods. Self examination at home reduces waiting times in health centers, with high demand of attention or during Covid pandemic. Barriers are mainly related with doubts in the self proficiency to perform the test and the accuracy of the results. Those doubts are understandable, because self sampling methods are never used before in Ecuador, and could be solved with an adequate training and information for the patients. Further studies that measure acceptability and sensitivity in real application are required to address the utility of self sampling methods in a rural context.