Study Characteristics, Methodological Assessment, Methodologies for Patients’ Perspectives and Experiences Review

Dr. Yi-Sheng Chao; Michelle Clark; Elizabeth Carson; Dr. Laura Weeks; Kristen Moulton; Dr. Susan McFaul; Dr. C.M McLauchlin; Dr. Bernice Tsoi; Umair Majid; Sujane Kandasamy; Neha Arora; Dr. Meredith Vanstone; Dr. Lynette Reid; Timothy Krahn; Kasia Kaluzny; Kelly Farrah; Caitlyn Ford

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Chao YS, Clark M, Carson E, et al. HPV Testing for Primary Cervical Cancer Screening: A Health Technology Assessment [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Mar. (CADTH Optimal Use Report, No. 7.1b.)

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HPV Testing for Primary Cervical Cancer Screening: A Health Technology Assessment [Internet].

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Appendix 13Study Characteristics, Methodological Assessment, Methodologies for Patients’ Perspectives and Experiences Review

Table 62Characteristics of Included Studies in the Patients’ Perspectives and Experiences Review

Author (Publication Year)	Country	Methodological and Analytic Approach	Participants	Data Collection	Study Objectives
Abdullahi et al. (2009)²¹⁶	UK	Thematic analysis	50 first-generation Somali immigrant women	Interviews; focus groups	To explore barriers to, and ways to improve, uptake of cervical screening among Somali women in Camden, London.
Ackerson (2010)²⁷³	US	Constant comparative analysis	24 African-American women	Interviews	To explore personal influencing factors that contribute to Pap smears in African-American women who do (routine-use group) and do not (non-routine-use group) obtain routine testing.
Ackerson et al. (2011)²⁰³	US	Content analysis	24 African-American women	Interviews	Explore inductively African-American women’s use of Pap smear screening services and consider how well the data did or did not affirm the usefulness of the interaction model of client health behaviour (IMCHB).
Ackerson (2012)²⁷⁶	US	Content analysis	15 African-American women	Interviews	To investigate the role of sexual and intimate partner violence in Pap smear avoidance behaviour in African-American women.
Ackerson et al. (2008)²⁵²	US	Qualitative description	7 African-American women with high school education or less and yearly income < $35,000	Interviews	A qualitative study exploring personal influences regarding Pap smears in low-income African-American women.
Adegboyega et al. (2017)²³⁴	US	Qualitative description	22 sub-Saharan African immigrant women	Focus groups; demographic questionnaires	To understand the factors influencing Pap smears among sub-Saharan African immigrant women.
Agenor et al. (2015)²⁷⁷	US	Thematic analysis	18 black lesbian, bisexual, and queer women	Focus groups	To understand the facilitators of and barriers to cervical cancer screening in black lesbian, bisexual, and queer (LBQ) women.
Agenor et al. (2016)¹⁷³	US	Grounded theory	32 transmasculine men; 17 clinicians	Interviews; focus groups	To understand the low rates of Pap smear use in transmasculine people.
Akhagba (2017)¹⁹⁵	Poland	Qualitative, not otherwise stated	12 migrant African women	Focus groups	To explore the knowledge and perception of migrant women about cervical cancer and other health-related issues; and to understand participants’ knowledge about cervical cancer screening, its benefits, and the sociocultural issues that impedes migrant women in the participation of the screening programs in Poland.
Anaman-Torgbor et al. (2017)¹⁸⁶	Australia	Thematic analysis	19 African immigrant women	Interviews	To describe barriers and facilitators of cervical screening practices among African immigrant women living in Brisbane, Australia.
Andrasik et al. (2008)²²²	US	Qualitative, not otherwise stated	35 low-income HIV-positive African-American women	Interviews	To elucidate the perspective of low-income HIV-positive African-American women who have not received cervical cancer screening for five or more years, on the barriers they face in accessing and using reproductive health care.
Andreassen et al. (2017)²⁵⁷	Romania	Qualitative, not otherwise stated	144 participants (9 interviews with 7 Roma and 2 non-Roma women; 78 participants in observation; 9 screening specialists in two focus groups; 48 Roma women in five focus groups)	Participant observations; interviews; focus groups	To explore Roma women’s (non)participation in cervical cancer screening program from women’s own perspective and those of health care providers and policy-makers.
Anhang et al. (2004)²³⁸	US	Grounded theory and adapted approaches	48 low-income women of various ethnic minorities	Focus groups	To investigate women’s questions and concerns about HPV or their attitudes toward HPV testing
Armstrong (2005)²⁶⁰	UK	Qualitative, not otherwise stated	Ethnic minority women (sample size not provided)	Interviews	To explore how individual women deal with, and react to, the very general information on cervical cancer risks they receive when invited to attend for cervical screening, and the general “at risk” position that is suggested to them through the official UK discourse on screening.
Armstrong (2007)²⁰¹	UK	Qualitative, not otherwise stated	36 women	Interviews	To explore how individual women interpret, negotiate, and make sense of this discourse in the context of their personal circumstances, experiences, and characteristics of cervical screening.
Armstrong (2012)²¹⁰	UK	Constant comparative analysis	34 women from diverse ethnic backgrounds	Interviews	To investigate this tension using women’s accounts of cervical screening, with a view to informing practice to better meet their needs.
Baker et al. (2012)¹⁸⁰	US	Community-based participatory research	44 Hmong women	Focus groups	To explore the barriers and facilitators of cancer screening among women of Hmong origin.
Barata et al. (2008)²⁷¹	Canada	Grounded theory and adapted approaches	44 northern Ontario residents	Focus groups	To explore women’s beliefs about collecting their own samples for HPV testing instead of participating in conventional Pap smears.
Bellinger et al. (2015)²⁶⁶	US	Content analysis	28 African-American women	Focus groups	To explore behaviour, knowledge, and attitudes as influences on health decisions and preferences for cervical cancer prevention and control among African-American women in South Carolina.
Black et al. (2011)²³⁵	Canada	Thematic analysis	80 Indigenous women	Focus groups	To evaluate young women’s knowledge of CCS and identifying barriers to and facilitators of participation in CCS.
Blake et al. (2015)²⁷⁵	US	Qualitative, not otherwise stated	24 African-American women	Interviews	To understand the cervical cancer experiences of women enrolled in Georgia’s Women’s Health Medicaid Program (WHMP).
Blomberg et al. (2008)¹⁷⁰	Sweden	Thematic analysis	86 women	Telephone interviews and fax messages	To explore how women who actively declined participation in the cost-free population-based cervical cancer screening program (PCCSP) reasoned about their choice.
Blomberg et al. (2011a)²¹⁷	Sweden	Content analysis	138 women	Face-to-face and online focus group discussions	To explore issues that 30-year-old women have addressed as encouraging CCS attendance, with particular focus on aspects susceptible to intervention.
Blomberg et al. (2011b)¹⁶⁷	Sweden	Interpretive description	38 women	Focus groups	To explore how 30-year-old women reason about health, ill health, health maintenance, and disease prevention, in relation to cervical cancer, its prevention, and screening.
Brown et al. (2007)²¹⁴	Canada	Grounded theory	20 women	Interviews	To investigate the role of stigma on HPV testing.
Brown et al. (2011)²⁴⁰	US	Thematic content analysis	44 Black women (Haitians, African immigrants, Anglophone-Caribbean immigrants, and African-Americans)	Focus groups	A descriptive study of cervical cancer screening knowledge, attitudes, beliefs, and practices among ethnically diverse black women.
Buetow et al. (2007)²¹⁹	New Zealand	Phenomenology	6 Maori women	Interviews	To enhance understanding of how having a cervical smear can lead some women not to keep up-to-date with this test.
Burke et al. (2004)²²⁷	US	Thematic content analysis	53 first-generation Vietnamese immigrant women	Interviews; focus groups	To identify cultural factors influencing Pap testing knowledge, including barriers and facilitators to testing; and to develop culturally appropriate intervention materials to increase knowledge about risk factors for cervical cancer and to increase Pap smear rates.
Byrd et al. (2007)¹⁷⁶	US	Qualitative, not otherwise stated	84 Hispanic women	Focus groups	To better understand the barriers and facilitators for Pap smears for Hispanic women.
Chang et al. (2013)²³¹	Canada	Content analysis	13 first-generation Chinese immigrant women	Focus groups	To delineate the mechanisms underlying low Pap smear rates among Chinese women living in North America.
Cohen et al. (2016)²⁴³	US	Framework analysis	24 medically underserved women in Appalachia	Interviews	To investigate how patient uncertainty concerning cervical cancer screening guidelines is appraised and managed through communication with health care providers.
Curmi et al. (2014)²⁵⁶	Australia	Thematic analysis	9 lesbian women	Interviews	To explore the attitudes and practices that lesbians have toward cervical cancer screening and aims to identify why such disparities occur.
Curmi et al. (2016)²³⁰	Australia	Thematic analysis	9 lesbian women	Interviews	To provide deeper insights into the experiences of lesbian women in accessing cervical cancer screening and to inform strategies to increase the uptake of these services for this group of women.
Donnelly (2006)¹⁹⁹	Canada	Qualitative, not otherwise stated	15 Vietnamese women; 6 clinicians	Interviews	To explore the participation of Vietnamese-Canadian women in screening for breast and cervical cancer; the appropriateness of current cancer-prevention services for Vietnamese women; and the influence of social, cultural, political, historical, and economic factors, shaped by race, gender, and class, on the screening practices of Vietnamese-Canadian women.
Donnelly et al. (2009)²⁶⁸	Canada	Qualitative, not otherwise stated	15 Vietnamese women; 6 clinicians	Interviews	To investigate the influence of socioeconomic factors on Vietnamese-Canadian women’s breast and cervical cancer screening behaviours.
Fernandez et al. (2009)²⁵¹	US	Ethnography	30 Hispanic women; 11 Hispanic men	Focus groups	To explore the level of HPV knowledge, attitudes, and cultural beliefs among Hispanic men and women on the Texas Mexico border.
Fletcher et al. (2014)²³²	US	Qualitative description with content analysis	33 low-income, HIVpositive women	Focus groups	To describe the barriers and facilitators related to cervical cancer screening in a sample of HIV-infected women seeking care at an integrated HIV clinic in Houston, Texas.
Flores et al. (2011)²⁶²	US	Case study	1 first-generation Mexican immigrant woman	Interview	To explore an older Mexican-American woman’s decision-making process to engage in cervical cancer screening.
Freeman et al. (2018)²¹⁸	England	Framework analysis	38 women over 50 years old	Interviews; focus groups	To assess the acceptability of non-speculum HPV testing for cervical screening in older women.
Friedman et al. (2012)¹⁸¹	US	Grounded theory	51 obese women	Interviews; focus groups	To explore obese women’s barriers to Pap smears and mammograms.
Gele et al. (2017)¹⁸⁷	Norway	Qualitative, not otherwise stated	18 Pakistani women; 17 Somali women	Focus groups	To obtain better insight into perceived barriers and challenges to cervical cancer screening among Somali and Pakistani women in the Oslo region.
Ghebre et al. (2015)²¹¹	US	Thematic analysis	23 Somali immigrant women	Interviews	To examine the barriers to and facilitators of cervical cancer screening among Somali immigrant women in Minnesota.
Goldman et al. (2004)²⁴⁷	US	Qualitative, not otherwise stated	74 Dominican and Puerto Rican women; 73 Dominican and Puerto Rican men	Interviews	This study explored perceptions of cancer, risk, and screening among Dominicans and Puerto Ricans in Rhode Island.
Grandahl et al. (2015)²³⁹	Sweden	Content analysis	50 immigrants	Focus groups	To explore immigrant women’s experiences and views on the prevention of cervical cancer, screening, HPV vaccination, and condom use.
Gregg et al. (2011a)²⁵⁸	US	Thematic analysis	28 Mexican immigrant women; 23 Mexican immigrant men	Interviews	To investigate beliefs about the Pap smear among Mexican immigrants.
Gregg et al. (2011b)²⁶⁴	US	Thematic analysis	31 Vietnamese women	Interviews	To understand the beliefs of Vietnamese-American women regarding the Pap smear.
Guilfoyle et al. (2007)²²⁸	US	Content analysis	98 low-income African-American and Hispanic older women	Focus groups	To investigate how low-income, African-American, and Hispanic older women make decisions about cervical cancer screening.
Hanlon & Payne (2018)²⁷²	New Zealand	Qualitative, not otherwise stated	11 women living with a physical impairment	Interviews	To identify experiences of women with physical impairments and their uptake of cervical cancer screening services in New Zealand.
Head et al. (2017)²⁶⁵	US	Thematic analysis	30 African-American women	Interviews	To evaluate patient understanding of HPV testing along with Pap smears.
Howard et al. (2009)²⁷⁸	Canada	Grounded theory	77 low socioeconomic status and immigrant women (Cantonese, Arab, Afghan, Somali, and Central American)	Focus groups	To understand the perceptions of lower SES and immigrant women regarding self-sampling for HPV.
Hulme et al. (2016)²²⁶	Canada	Grounded theory	37 South Asian and Chinese immigrant women	Interviews; focus groups	To better understand how Chinese and South Asian immigrants conceive of breast and cervical cancer screening.
Johnson et al. (2016)¹⁶⁶	US	Content analysis	226 lesbian and bisexual women and transgender men; (226 surveys; 20 in depth interviews)	Interviews; online questionnaire	To examine cervical cancer screening behaviours of LBQ women and transgender men using American Cancer Society guidelines as the standards for comparison and to determine factors that influence participation in cervical cancer screening.
Katz et al. (2016)²⁰⁷	US	Qualitative, not otherwise stated	15 women from a rural area; 28 clinicians	Focus groups	To understand the perceived acceptability of mailed HPV self-tests among Appalachian Ohio women.
Kim et al. (2004)¹⁹¹	US	Qualitative, not otherwise stated	16 Korean women	Focus groups	To describe the perceptions about cervical cancer and factors related to cervical cancer screening among Korean-American women.
Kim et al. (2017)²⁴¹	US	Qualitative description	32 Korean immigrant women	Interviews	To explore decision-making about Pap smears among Korean immigrant women.
Kue et al. (2014)¹⁹³	US	Qualitative, not otherwise stated	44 Hmong women; 39 Hmong men	Interviews	To explore Hmong women and men’s perceptions of breast and cervical cancer and cancer screening, women’s experiences with breast and cervical cancer screening, and health care system barriers to screening.
Kwok et al. (2011)²⁰⁴	Australia	Content analysis	18 Chinese immigrant women	Interviews	To understand the different facilitators and barriers to screening for Chinese Australian women.
Laranjeira (2013)²⁴⁵	Portugal	Constant comparative analysis	25 women	Interviews	To investigate Portuguese women’s knowledge and beliefs about cervical cancer screening.
Lee et al. (2014)⁵¹⁴	US	Thematic content analysis	30 Korean and Vietnamese women	Interviews	To explore multilevel factors that may underlie low screening rates among Vietnamese-American Women and Korean-American women living in a city where their ethnic communities are relatively small.
Lee et al. (2017)¹⁸⁸	US	Thematic analysis	16 Korean immigrant women	Focus groups	To identify major barriers to Pap test uptake and HPV vaccine acceptability for Korean immigrant women.
Lewis et al. (2002)¹⁹⁶	US	Qualitative, not otherwise stated	47 African-American and Hispanic women	Focus groups	To understand the barriers to breast and cervical cancer screening among New Jersey African-Americans and Latinas.
Logan et al. (2011)¹⁷⁸	UK	Thematic content analysis	48 women from a “socially deprived area”	Focus groups	To explore women’s knowledge, experiences, and perceptions of cervical cancer screening in an area of social deprivation.
Lor et al. (2013)²⁰⁵	US	Qualitative description with content analysis	16 Hmong women	Interviews	To describe the beliefs, feelings, norms, and external conditions regarding breast and cervical cancer screening in a sample of Hmong women.
Lovell et al. (2007)²⁷⁹	New Zealand	Thematic analysis	17 Maori women, Chinese women; Korean women; women of low socioeconomic status; 9 clinicians	Interviews	To investigate why underscreening persists in a country where cervical screening has a high profile and how the promotion of cervical screening has impacted the decisions of women to undergo a smear test.
Lyttle et al. (2006)²⁰⁰	US	Qualitative, not otherwise stated	69 low-income women from a rural area	Focus groups	To obtain an understanding of attitudes about breast and cervical cancer screening among women aged 25 to 64 years; to determine factors that motivate women to be screened for breast and cervical cancer; and to evaluate educational materials about breast and cervical cancer screening for use in this population.
MacDonald et al. (2015)¹⁶⁸	Canada	Thematic analysis	18 Indigenous (Mi’kmaq) women; 3 clinicians	Talking circles; interviews	To explore Mi’kmaq women’s experiences with Pap smears within the contexts that shaped their experiences using postcolonial feminist perspectives and Indigenous principles.
Magee et al. (2005)¹⁹⁸	US	Thematic analysis	42 prison inmate women; 4 clinicians	Interviews	To determine what is and is not working with the Pap smear and follow-up treatment for women in prison.
Manderson et al. (2006)¹⁶⁹	Australia	Community-based collaborative research; case study	323 Australian-Indigenous women; 45 community members; 179 clinicians	Interviews; focus groups; community meetings; case histories	To explore the different cultural and structural factors affecting understanding and awareness of cervical cancer and Indigenous women’s use of and access to health services for screening, diagnosis and treatment.
Marlow et al. (2009)²⁶³	UK	Framework analysis	21 women	Interviews	To identify the key questions about HPV that British women will ask when considering having an HPV test or vaccination.
Marlow et al. (2015)¹⁸⁵	UK	Framework analysis	43 women representing various ethnic minorities (Indian, Pakistani, Bangladeshi, Caribbean, African, Black)	Interviews	To explore self-perceived barriers to cervical screening attendance among ethnic minority women compared with white British women.
Martin et al. (2004)²²⁴	US	Qualitative, not otherwise stated	20 Muslim women	Focus groups	To examine the impact of religious and cultural values on health care behaviour of Muslim women from immigrant backgrounds in the San Francisco Bay Area, particularly with regard to cervical cancer screening; to determine whether these women would welcome discussing values and beliefs regarding sexuality and reproductive health.
Matthews et al. (2006)²⁴⁴	US	Thematic analysis	94 African-Americans	Focus groups	To evaluate the CDC Racial and Ethnic Approaches to Community Health (REACH) 2010 faith-based breast and cervical cancer early detection and prevention intervention for African-American women living in urban communities.
McAlearney et al. (2012)²⁵⁵	US	Grounded theory and adapted approaches	36 women from a rural area	Focus groups	To explore Appalachian women’s perceptions of trust and distrust of health care providers and the medical care system as they relate to views about cervical cancer and screening.
McCaffery (2003)²⁸⁰	UK	Framework analysis	71 Indian women; Pakistani women; African-Caribbean women	Focus groups	To examine attitudes to HPV testing among a purposively selected sample of women from four ethnic groups: white British, African-Caribbean, Pakistani, and Indian.
McCaffery (2006)²⁸²	UK	Framework analysis	74 South Asian (including Pakistani, Indian, and east African Asian) and African-Caribbean women	Interviews	To examine the social and psychological impact of HPV testing in the context of cervical cancer screening.
McDowell et al. (2017)¹⁷⁴	US	Thematic analysis	31 transmasculine individuals (interviews); 32 transmasculine individuals (surveys)	Interviews; online survey with open-ended questions	To elucidate cervical cancer screening preferences among transmasculine individuals.
McLachlan et al. (2018)¹⁹⁰	Australia	Grounded theory	40 women; 7 health professionals	Interviews	To identify and understand clinical and personal enablers that assisted women to complete self-collection cervical screening pathways successfully.
McRae et al. (2014)²³⁷	Ireland	Thematic analysis	59 women	Focus groups	To investigate Irish women’s attitudes toward the transformation of cervical cancer prevention.
Menard et al. (2010)¹⁹²	US	Grounded theory	15 Haitian immigrant women	Interviews	To understand the barriers to cervical cancer screening among Haitian immigrant women.
Miller et al. (2007)²²⁵	US	Thematic analysis	32 women with a mental illness; 35 clinicians	Interviews; focus groups	To explore challenges to accessing and providing breast and cervical cancer screening for women with mental illness.
Moravac (2018)²²³	Canada	Thematic analysis	26 homeless women with severe mental health challenges	Interviews	To explore the factors that influence breast and cervical cancer screening decisions among homeless women and women with mental health challenges residing in Toronto, Canada.
Ndukwe et al. (2013)²²⁹	US	Qualitative, not otherwise stated	38 African immigrant women	Interviews; focus groups; sociodemographic questionnaire	To investigate knowledge and awareness levels of breast and cervical cancer screening practices among female African-born immigrants to the US residing in the Washington, DC, metropolitan area.
Nolan et al. (2014)²⁴⁶	US	Grounded theory	17 African-American women; 42 clinicians	Focus groups	To explore factors that might lead to delays in appropriate cervical cancer screening and diagnosis among black women in Massachusetts.
O’Brien et al. (2009)²⁰²	Canada	Ethnography	8 Indigenous (Cree) women	Focused ethnography; interviews	To explore attitudes and beliefs of First Nation Cree women living in a reserve community to gain insights into how cervical screening could be better utilized.
Oelke et al. (2007)²⁵⁴	Canada	Qualitative description	53 Sikh women	Interviews; focus groups	To investigate Sikh women’s perspectives on cervical cancer screening.
Oscarsson et al. (2008)²²⁰	Sweden	Content analysis	14 women	Interviews	To describe and interpret why women with no cervical smear taken during the previous 5 years choose not to attend a cervical cancer screening program.
Penaranda et al. (2014)¹⁸⁴	US	Thematic analysis	21 Hispanic women	Focus groups	To investigate attitudes toward self-sampling for cervical cancer screening among primary care attendees living on the US–Mexico border.
Peitzmeier et al. (2017)¹⁷⁵	US	Grounded theory and adapted approaches	32 transmasculine individuals	Interviews	To examine the factors influencing Pap test utilization among transmasculine individuals to inform evidence-based interventions to promote regular cervical cancer screening in this medically underserved population.
Pinzon-Perez et al. (2005)²⁶⁹	US	Phenomenology	51 Latina women from a rural area	Interviews	To identify alterable determinants of Pap smear screening for Latino women living in a rural area of California.
Pratt et al. (2017)²³³	US	Constructivist grounded theory	34 Somali women, 20 Somali men	Focus groups	To investigate the views of Somali women and men on the use of faith-based messages promoting breast and cervical cancer screening for Somali women.
Racey et al. (2016)²⁰⁸	Canada	Thematic analysis	25 women from a rural area	Focus groups	To explore the initial reaction and perception to HPV self-collected testing, in the context of current barriers and facilitators to cervical cancer screening, among women in an underscreened community in rural Ontario.
Redwood-Campbell et al. (2011)¹⁷⁹	Canada	Case study	77 immigrant women of low socioeconomic status	Focus group	To describe the similarities and differences among multiple groups of immigrant women and Canadian-born women of low socioeconomic status regarding barriers and enablers associated with cervical cancer screening, in order to inform core elements of a strategy that would be acceptable across multiple underscreened groups.
Scarinci et al. (2013)¹⁸³	US	Qualitative, not otherwise stated	96 African-American women	Focus groups; discussion group	To inform the development of interventions to promote cervical cancer screening in African-American women in the Mississippi Delta by examining the acceptability and usability of self-collected sampling for HPV testing.
Schoenberg et al. (2005)²¹⁵	US	Grounded theory and adapted approaches	25 women from a lowincome, rural area	Interviews	To investigate the determinants of cervical cancer screening among central Appalachian women.
Schoenberg et al. (2013)²⁵³	US	Qualitative, not otherwise stated	60 rural women; 19 clinicians	Interviews; focus groups	To better understand barriers to, and facilitators of, breast and cervical cancer screening among Appalachian women and to identify strategies to increase cancer screening.
Seo et al. (2018)¹⁸⁹	US	Phenomenology	12 Chinese-American immigrant women	Interviews	To understand the experiences and perceptions of having cervical cancer screening tests and to explore the extant barriers to having the tests among first-generation Chinese-American women in the US.
Smith et al. (2003)²⁴⁹	US	Thematic analysis	68 women	Focus groups	To explore attitudes, beliefs, and perceived barriers to risk-based cervical cancer screening through focus group interviews of patients.
Stewart et al. (2010)²⁴²	Australia	Content analysis	24 women	Interviews	To explore patient expectations and experiences regarding Pap smear and associated screening activities.
Szalacha et al. (2016)¹⁹⁴	US	Content analysis	47 Mexican women	Focus groups	To qualitatively examine an alternative framework for examining cultural influences on Mexican-heritage Latinas’ nderstandings of breast and cervical cancer screening and how to leverage their beliefs to positively influence screening practices.
Szarewski (2009)¹⁷⁷	UK	Framework analysis	28 Muslim women	Focus groups	To explore Muslim women’s attitudes about self-sampling for HPV in the context of cervical cancer screening and their responses to two self-sampling devices.
Thorburn et al. (2013a)²⁷⁴	US	Content analysis	44 Hmong women; 39 Hmong men	Interviews	To explore sources of information about breast and cervical cancer, including screening, and identify barriers to seeking such information for Hmong women and men.
Thorburn et al. (2013b)²¹²	US	Content analysis	44 Hmong women; 39 Hmong men	Interviews	To explore family and clan influences on Hmong women’s breast and cervical cancer screening attitudes and behaviour.
Van Til et al. (2003)¹⁹⁷	Canada	Thematic analysis	60 older women	Focus groups	To understand the barriers to cervical cancer screening among older women.
Vanslyke et al. (2008)²⁵⁰	US	Thematic analysis	54 Hispanic women	Focus groups	To investigate the knowledge, beliefs, and attitudes among Hispanic women toward HPV and cervical cancer testing and prevention.
Wakewich et al. (2016)²¹³	Canada	Qualitative, not otherwise stated	69 Indigenous women; 16 clinicians	Interviews; focus groups	To investigate the Colonial legacy and the experience of First Nations women in cervical cancer screening.
Waller et al. (2005)²⁸¹	UK	Framework analysis	74 South Asian (including Pakistani, Indian, and east African Asian) and African-Caribbean women (This might be the same population of women used in McCaffery 2006)	Interviews	To examine how women make sense of information about HPV in the context of cervical cancer screening.
Waller et al. (2012)¹⁸²	UK	Framework analysis	46 women; 12 clinicians	Interviews	To examine how women make sense of information about HPV in the context of cervical cancer screening.
Williams et al. (2015)²³⁶	US	Content analysis	20 HIV-positive African-American women	Interviews	To examine sociocultural and structural factors associated with cervical cancer screening among HIV-infected African-Americans in Alabama.
Wittenberg et al. (2015)²⁰⁶	US	Thematic analysis	42 homeless women	Focus groups	To assess homeless women’s preferences for cervical cancer screening interventions.
Wollin et al. (2003)²⁶⁷	Australia	Qualitative, not otherwise stated	13 low-income deaf women	Interviews	To assess baseline knowledge about mammograms and pap smears among Australian deaf women, to investigate their participation in breast and cervical cancer screening services, and to explore, where relevant, their perceptions about their access to breast and cervical screening services.
Wong et al. (2010)²⁰⁹	US	Qualitative, not otherwise stated	10 Chuukese women	Interviews	To describe the knowledge, attitudes, and beliefs of Chuukese women in Hawaii regarding cervical cancer prevention and screening.
Wu et al. (2010)²⁷⁰	US (American Samoa)	Ethnography	55 Samoan women	Focus groups	To gain a better understanding of issues that may prevent women in American Samoa from using available cancer screening resources.
Zehbe et al. (2016)²⁵⁹	Canada	Qualitative, not otherwise stated	69 Indigenous women; 16 clinicians	Interviews; focus groups	To investigate the challenges and barriers associated with designing screening programs aimed to specifically reach Indigenous women.
Zehbe et al. (2017)²²¹	Canada	Qualitative, not otherwise stated	69 Indigenous women; 16 clinicians	Interviews; focus groups	To investigate whether First Nations women preferred HPV self-sampling over health care provider–administered Pap screening.

: CCS = cervical cancer screening; CDC = Centers for Disease Control and Prevention; IMCHB = Cox’s Interaction Model of Client Health Behavior; LBQ = lesbian, bisexual, queer; Pap = Papanicolaou test; SES = socioeconomic status.

Table 63Methodological Assessment of Studies Included in the Patients’ Perspectives and Experiences Review

Study Author(s) (Year)	1. Was There a Clear Statement of the Aims of the Research?	2. Is a Qualitative Methodology Appropriate?	3. Was the Research Design Appropriate to Address the Aims of the Research?	4. Was the Recruitment Strategy Appropriate to the Aims of the Research?	5. Was the Data Collected in a Way That Addressed the Research Issue?	6. Has the Relationship Between Researcher and Participants Been Adequately Considered?	7. Have Ethical Issues Been Taken into Consideration?	8. Was the Data Analysis Sufficiently Rigorous?	9. Is There a Clear Statement of Findings?	10. How Relevant is the Research to the Current Review?
Abdullahi et al. (2009)²¹⁶	2	2	1	2	2	0	2	2	2	Highly relevant
Ackerson (2010)²⁷³	2	2	1	2	2	0	2	2	2	Relevant
Ackerson et al. (2011)²⁰³	2	2	2	2	2	0	2	2	2	Relevant
Ackerson (2012)²⁷⁶	2	2	1	2	2	0	2	2	0	Highly relevant
Ackerson et al. (2008)²⁵²	2	2	1	1	1	0	2	0	0	Relevant
Adegboyega et al. (2017)²³⁴	2	2	1	2	2	0	2	2	2	Highly relevant
Agenor et al. (2015)²⁷⁷	2	2	0	2	2	0	2	2	2	Highly relevant
Agenor et al. (2016)¹⁷³	2	2	0	1	2	0	2	2	2	Somewhat relevant
Anaman-Torgbor et al. (2017)¹⁸⁶	2	2	2	2	2	2	0	2	2	Relevant
Andrasik et al. (2008)²²²	2	2	1	1	2	0	2	0	2	Highly relevant
Andreassen et al. (2017)²⁵⁷	2	2	2	1	2	2	2	2	2	Relevant
Anhang et al. (2004)²³⁸	2	2	2	2	2	0	2	2	2	Relevant
Armstrong (2005)²⁶⁰	2	2	2	2	2	0	0	0	0	Somewhat relevant
Armstrong (2007)²⁰¹	2	2	2	2	2	0	0	2	2	Somewhat relevant
Armstrong (2012)²¹⁰	2	2	2	2	2	2	2	2	2	Somewhat relevant
Baker et al. (2012)¹⁸⁰	2	2	1	2	2	1	0	2	2	Highly relevant
Barata et al. (2008)²⁷¹	2	2	1	2	2	0	2	2	2	Highly relevant
Bellinger et al. (2015)²⁶⁶	2	2	2	1	2	2	2	2	2	Somewhat relevant
Black et al. (2011)²³⁵	2	2	2	2	2	0	2	2	2	Highly relevant
Blake et al. (2015)²⁷⁵	2	2	0	1	1	0	1	2	2	Somewhat relevant
Blomberg et al. (2008)¹⁷⁰	2	2	0	0	2	2	2	2	2	Highly relevant
Blomberg et al. (2011a)²¹⁷	2	2	2	2	2	0	1	2	2	Highly relevant
Blomberg et al. (2011b)¹⁶⁷	2	2	2	2	2	2	0	2	2	Somewhat relevant
Brown et al. (2007)²¹⁴	2	2	0	2	2	0	0	2	2	Highly relevant
Brown et al. (2011)²⁴⁰	2	2	1	2	2	0	2	2	0	Somewhat relevant
Buetow et al. (2007)²¹⁹	2	2	2	2	2	0	0	2	0	Relevant
Burke et al. (2004)²²⁷	2	2	2	1	2	0	2	2	2	Somewhat relevant
Byrd et al. (2007)¹⁷⁶	2	2	2	2	2	0	2	2	2	Highly relevant
Chang et al. (2013)²³¹	2	2	2	1	2	0	2	2	2	Somewhat relevant
Cohen et al. (2016)	2	2	0	2	0	2	0	2	2	Relevant
Curmi et al. (2014)²⁵⁶	2	2	2	1	2	2	2	0	2	Highly Relevant
Curmi et al. (2016)²³⁰	2	2	2	2	1	2	2	0	2	Relevant
Donnelly (2006)¹⁹⁹	2	2	1	1	2	0	2	2	0	Relevant
Donnelly et al. (2009)²⁶⁸	2	2	0	2	1	0	2	2	2	Relevant
Fernandez et al. (2009)²⁵¹	2	2	2	2	2	2	2	2	2	Relevant
Fletcher et al. (2014)²³²	2	2	1	2	2	0	2	2	2	Somewhat relevant
Flores et al. (2011)²⁶²	2	2	2	2	1	0	2	0	2	Somewhat relevant
Freeman et al. (2018)²¹⁸	2	2	2	1	2	0	0	0	2	Somewhat relevant
Friedman et al. (2012)¹⁸¹	2	2	1	2	2	0	2	2	2	Relevant
Gele et al. (2017)¹⁸⁷	2	2	2	1	2	0	0	2	2	Relevant
Ghebre et al. (2015)²¹¹	2	2	2	1	2	0	0	2	2	Relevant
Goldman et al. (2004)²⁴⁷	2	2	2	1	2	1	1	2	2	Highly Relevant
Grandahl et al. (2015)²³⁹	2	2	2	2	2	0	0	2	2	Highly relevant
Gregg et al. (2011a)²⁵⁸	2	2	2	2	2	1	1	2	2	Somewhat relevant
Gregg et al. (2011b)²⁶⁴	2	2	2	2	2	1	1	2	2	Somewhat relevant
Guilfoyle et al. (2007)²²⁸	2	2	2	2	2	1	2	2	2	Highly relevant
Hanlon and Payne (2018)²⁷²	2	2	1	0	2	0	0	0	2	Relevant
Head et al. (2017)²⁶⁵	2	2	2	2	2	0	1	2	2	Somewhat relevant
Howard et al. (2009)²⁷⁸	2	2	2	2	2	0	1	2	2	Somewhat relevant
Hulme et al. (2016)²²⁶	2	2	2	2	2	1	2	2	2	Highly relevant
Johnson et al. (2016)¹⁶⁶	2	2	2	2	2	0	1	1	1	Somewhat relevant
Katz et al. (2016)²⁰⁷	2	2	2	2	2	0	1	2	2	Relevant
Kim et al. (2004)¹⁹¹	2	2	2	2	2	1	1	2	2	Highly relevant
Kim et al. (2017)²⁴¹	2	2	2	2	2	1	1	2	2	Highly relevant
Kue et al. (2014)¹⁹³	2	2	2	2	2	0	1	2	2	Highly relevant
Kwok et al. (2011)²⁰⁴	2	2	2	2	2	0	1	1	2	Relevant
Laranjeira (2013) ²⁴⁵	2	2	2	0	1	0	1	1	1	Highly relevant
Lee et al. (2014)⁵¹⁴	2	2	2	2	1	1	0	2	2	Highly relevant
Lee and Lee (2017)¹⁸⁸	2	2	2	0	2	0	0	2	2	Somewhat relevant
Lewis et al. (2002)¹⁹⁶	2	2	2	2	2	2	0	0	2	Somewhat relevant
Logan et al. (2011)¹⁷⁸	2	2	2	2	2	0	2	2	2	Relevant
Lor et al. (2013) ²⁰⁵	2	2	2	2	2	1	1	2	2	Relevant
Lovell et al. (2007)²⁷⁹	2	2	2	2	2	1	1	1	2	Somewhat relevant
Lyttle et al. (2006)²⁰⁰	2	2	2	2	2	2	0	2	2	Relevant
MacDonald et al. (2015)¹⁶⁸	2	2	2	2	2	0	2	2	2	Highly relevant
Magee et al. (2005)¹⁹⁸	2	2	2	2	2	0	1	2	2	Relevant
Manderson et al. (2006)¹⁶⁹	2	2	2	2	2	0	2	2	2	Relevant
Marlow et al. (2009)²⁶³	2	2	2	1	1	0	2	1	1	Relevant
Marlow et al. (2015)¹⁸⁵	2	2	2	2	2	0	1	2	1	Relevant
Martin et al. (2004)²²⁴	2	2	2	2	2	0	2	2	2	Highly relevant
Matthews et al. (2006)²⁴⁴	2	2	2	2	2	1	0	2	2	Somewhat relevant
McAlearney et al. (2012)²⁵⁵	2	2	2	2	2	2	2	2	2	Somewhat relevant
McCaffery (2003)²⁸⁰	2	2	2	2	2	0	2	2	2	Relevant
McCaffery (2006)²⁸²	2	2	2	2	2	0	0	0	0	Somewhat relevant
McDowell et al. (2017)¹⁷⁴	2	2	2	1	2	0	0	2	2	Relevant
McLachlan et al. (2018)¹⁹⁰	2	2	2	2	1	0	0	1	2	Highly relevant
McRae et al. (2014)²³⁷	2	2	2	2	2	0	2	2	2	Highly relevant
Menard et al. (2010)¹⁹²	2	2	2	2	2	0	0	2	2	Relevant
Miller et al. (2007)²²⁵	2	2	2	2	2	0	2	0	2	Somewhat relevant
Moravac (2018)²²³	2	2	1	1	1	0	0	0	2	Highly relevant
Ndukwe et al. (2013)²²⁹	2	2	2	2	2	0	2	2	2	Somewhat relevant
Nolan et al. (2014)²⁴⁶	2	2	2	2	2	2	2	2	2	Relevant
O’Brien et al. (2009)²⁰²	2	2	2	2	2	0	2	0	2	Highly relevant
Oelke et al. (2007)²⁵⁴	2	2	2	2	2	0	2	2	2	Relevant
Oscarsson et al. (2008)²²⁰	2	2	2	2	2	0	2	2	2	Highly relevant
Peitzmeier et al. (2017)¹⁷⁵	2	2	2	2	2	2	0	2	2	Relevant
Penaranda et al. (2014)¹⁸⁴	2	2	2	0	2	0	2	2	2	Relevant
Pinzon-Perez et al. (2005)²⁶⁹	2	2	2	2	2	0	2	2	2	Relevant
Pratt et al. (2017)²³³	2	2	2	2	2	0	2	2	1	Somewhat relevant
Racey et al. (2016)²⁰⁸	2	2	2	2	2	2	2	2	2	Relevant
Redwood-Campbell et al. (2011)¹⁷⁹	2	2	2	2	2	2	2	2	2	Somewhat relevant
Scarinci et al. (2013)¹⁸³	2	2	2	2	2	0	2	2	2	Somewhat relevant
Schoenberg et al. (2005)²¹⁵	2	2	2	2	2	2	2	2	2	Relevant
Schoenberg et al. (2013)²⁵³	2	2	2	2	2	2	2	2	2	Relevant
Seo et al. (2017)¹⁸⁹	2	2	2	2	2	0	1	2	2	Relevant
Smith et al. (2003)²⁴⁹	2	2	2	2	2	2	2	2	2	Highly relevant
Stewart et al. (2010)²⁴²	2	2	2	2	2	0	2	2	2	Highly relevant
Szalacha et al. (2016)¹⁹⁴	2	2	2	2	2	2	2	2	2	Highly relevant
Szarewski (2009)¹⁷⁷	2	2	2	2	2	0	2	2	2	Relevant
Thorburn et al. (2013a)²⁷⁴	2	2	2	2	2	2	2	2	2	Somewhat relevant
Thorburn et al. (2013b)²¹²	2	2	2	2	2	2	2	2	2	Somewhat relevant
Van Til et al. (2003)¹⁹⁷	2	2	2	2	2	0	2	2	2	Highly relevant
Vanslyke et al. (2008)²⁵⁰	2	2	2	2	2	0	2	2	2	Relevant
Wakewich et al. (2016)²¹³	2	2	2	2	2	2	2	2	2	Highly relevant
Waller et al. (2005)²⁸¹	2	2	1	2	2	0	0	2	2	Somewhat relevant
Waller et al. (2012)¹⁸²	2	2	2	2	2	0	2	2	2	Highly relevant
Williams et al. (2015)²³⁶	2	2	2	2	2	0	2	2	2	Relevant
Wittenberg et al. (2015)²⁰⁶	2	2	2	2	2	2	2	2	2	Somewhat relevant
Wollin et al. (2003)²⁶⁷	2	2	2	2	2	0	2	0	2	Somewhat relevant
Wong et al. (2010)²⁰⁹	2	2	2	0	2	2	2	0	2	Somewhat relevant
Wu et al. (2010)²⁷⁰	2	2	2	2	2	0	2	2	2	Somewhat relevant
Zehbe et al. (2016)²⁵⁹	2	2	2	2	2	0	2	2	2	Somewhat relevant
Zehbe et al. (2017)²²¹	2	2	2	2	2	2	2	2	2	Highly relevant

: Note: Each paper was assessed independently by two reviewers. Each reviewer assigned a score of 1 or 0 for each criterion of each paper and the sum of these scores is presented in this table. A score of 0 means that the reviewer was unable to see evidence that a particular criterion was achieved. We decided on the relevance of each paper after the analysis was completed, by examining how broadly that paper was used in the analysis.

Table 64Methodology of Included Studies in the Patients’ Perspectives and Experiences Review

Study Design	Number of Studies
Thematic analysis / thematic content analysis	32 (27.4%)
Qualitative not otherwise specified	28 (23.9%)
Content analysis	15 (12.8%)
Grounded theory and adapted processes / constant comparative analysis	16 (13.7%)
Framework analysis	10 (8.5%)
Other (interpretive description, community-based participatory research, phenomenology, case study)	7 (6.0%)
Qualitative description	6 (5.1%)
Ethnography	3 (2.6%)
Total	117 (100%)

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Chao YS, Clark M, Carson E, et al. HPV Testing for Primary Cervical Cancer Screening: A Health Technology Assessment [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Mar. (CADTH Optimal Use Report, No. 7.1b.) Appendix 13, Study Characteristics, Methodological Assessment, Methodologies for Patients’ Perspectives and Experiences Review.
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