Human papillomavirus self-sampling for cervical cancer screening in Portugal: a mixed-methods acceptability study among socially vulnerable migrant women

Abstract Background Cervical cancer is a public health concern. Although it is preventable through regular screening, participation in screening programmes remains suboptimal among women living in socially vulnerable situations and migrants due to barriers to conventional screening programmes. Consequently, these women experience disproportionately higher incidence and mortality rates, underscoring inequities in cervical cancer outcomes. Human Papillomavirus (HPV) self-sampling has emerged as a promising strategy to mitigate these barriers and enhance access to preventive reproductive health services. However, evidence of its acceptability in community settings is limited. Drawing on a culturally adapted HPV self-sampling intervention, this study aimed to explore the acceptability of HPV self-sampling among socially vulnerable migrant women in community settings in Lisbon. Methods We conducted a sequential mixed-methods study among 111 socially vulnerable migrant women aged 30–65 years who participated in an HPV self-sampling intervention delivered through community-based organisations in Lisbon. The quantitative component consisted of a pre–post questionnaire assessing anticipated and experienced acceptability of HPV self-sampling. The qualitative component involved mini–focus group discussions with eight intervention participants to explore experiences in greater depth. Quantitative data were analysed using the Wilcoxon signed-rank test in R, and qualitative data were analysed thematically informed by the Theoretical Framework of Acceptability. Results Our findings indicate high perceived acceptability of HPV self-sampling. Pre–post comparisons showed statistically significant changes (p < 0.05) in trust in test results, perceived ease and comfort, confidence in self-sampling, and the speed of the process, alongside reductions in pain, nervousness, embarrassment, and the need for help. Qualitative data contextualised these findings: women valued the privacy, simplicity, and trust. However, concerns regarding correct test performance and positive results were identified. Clear instructions and community settings emerged as perceived enablers. Conclusion HPV self-sampling was perceived as acceptable among socially vulnerable migrant women. These findings may inform considerations for cervical cancer screening implementation aimed at expanding access to cervical cancer prevention with respect to how HPV self-sampling is introduced, facilitated, and supported within trusted community settings. Further research is needed to assess whether perceived acceptability translates into sustained screening uptake and equitable screening participation across diverse implementation settings.