Acceptability of diagnostic tampon self-sampling for HPV: Mixed methods findings from the STAMP Trial and focus groups

BackgroundMultiple barriers limit access to traditional in-person clinician sampling for cervical cancer. The STAMP (Screening with Tampons: Evaluating Diagnostic Accuracy for HPV and Assessing Participant Views) study evaluated the diagnostic accuracy and acceptability of tampon-based self-sampling for HPV amongst people assigned female at birth. Encouraging technical performance of the tampon as a sample for microbial detection was observed relative to clinician-taken samples. Pre and post trial questionnaires and a nested qualitative study explored acceptability. MethodsAll participants (n=263) completed questionnaires before and after sampling using three methods: tampon-based self-sampling, swab-based self-sampling, and clinician-collected samples. Questions included comfort, trust and ease of use of tampon-sampling. Four focus groups (n=24) were conducted online, and analysed using reflexive thematic analysis. ResultsQuestionnaire responses suggested tampon-based self-sampling was highly acceptable. Qualitative analysis identified four key themes: advantages of self-sampling over clinician-sampling; unique benefits of tampon-based self-sampling; concerns about accuracy and trust; and confidence in correct use. Participants valued the physical comfort, psychological ease, and practical convenience of self-sampling compared to clinician-sampling. The familiarity of tampons as an everyday product was central to acceptability, normalising screening. While some initially questioned accuracy, most were reassured by evidence of performance. Clear instructions and understanding the evidence base boosted confidence. ConclusionFindings suggest that tampon-based self-sampling is a highly acceptable alternative sampling approach for cervical screening that may increase screening participation by addressing multiple barriers. Implementation strategies should emphasise the methods everyday nature, while providing accessible guidance to support correct usage. What is already known on this topicO_LISelf-sampling for Human Papillomavirus (HPV) has been recommended by the World Health Organisation as an additional approach to expand cervical cancer screening services, complementing conventional clinician-taken sampling to broaden access and address barriers associated with in-person care. C_LI What this study addsO_LIFindings from this study suggest that self-sampling has the potential to support screening for cervical cancer as an acceptable, at-home approach addressing physical, psychological and practical barriers associated with traditional clinician collected sampling. C_LIO_LIParticipants reported that the familiarity of using a tampon for self-sampling creates a unique advantage over other self-sampling methods through demedicalising and normalising screening, therefore potentially increasing accessibility and participation among underscreened populations who experience most barriers. C_LI How this study might affect research, practice or policyO_LISelf-sampling including tampon-based self sampling offers a promising, acceptable approach to achieving cancer elimination goals. C_LIO_LIImplementation of tampon-based self-sampling for HPV should be clear, comprehensive and accessible, incorporating visual aids and simple language while emphasising the rationale and scientific evidence behind the collection method C_LI