Sociodemographic factors predicting preference for human papillomavirus self-sampling in cervical cancer screening: comparison of opt-out and opt-in strategies

Human papillomavirus self-sampling may improve cervical cancer screening uptake and equity in cancer prevention. This study aimed to identify sociodemographic factors associated with preference for self-sampling in opt-out (mailed directly) and opt-in (web-order) strategies. The study population included screening participants in the intervention group of a randomized study within the Estonian cervical screening target population in 2021. Preference for self-sampling over clinician sampling was studied among screening participants in opt-out (n = 5335) and opt-in (n = 4362) arms in relation to sociodemographic factors; prevalence ratios with 95% confidence intervals (CI) were calculated using Poisson regression. More women preferred self-sampling in the opt-out than in the opt-in arm (47.6 vs. 23.0%; P < 0.001). In the opt-out arm, self-sampling preference was higher among women aged 60/65 years (multivariable prevalence ratios: 1.36, 95% CI = 1.25-1.48, P < 0.001) compared with age group 30/35 years. In the opt-in arm, self-sampling preference was lower among women aged 50/55 years (prevalence ratios: 0.68, 95% CI = 0.57-0.81, P < 0.001) and 60/65 (prevalence ratios: 0.83, 95% CI = 0.70-0.99, P = 0.036) compared with age group 30/35 years, and other native language speakers were 46% (P < 0.001) less likely to choose self-sampling compared with native Estonian speakers. Uninsured women were more likely to prefer self-sampling, regardless of strategy. The study findings support the implementation of different targeted opt-out or opt-in approaches in various sociodemographic groups in Estonia. Each country should evaluate appropriate context-specific strategies for its population subgroups.