The introduction of the Pap test has led to significant reductions in cervical cancer incidence and mortality in
the US. However, screening rates are suboptimal in many Asian American subgroups, and remain persistently
lower than rates in non-Hispanic White, non-Hispanic Black, and Hispanic women. Studies report that Korean
and Vietnamese American women, in particular, have among the lowest rates of screening compared to other
ethnic/racial groups. Multiple factors may contribute to non-screening among Asian American women.
Embarrassment, cost, lack of insurance or regular healthcare provider, lack of time, and language difficulties
are key barriers to screening in this population. Emerging technologies supporting self-sampling for human
papillomavirus (HPV) testing may offer a valuable, evidence-based strategy for empowering Asian American
women who have been resistant -- or unable -- to obtain clinic-based cervical cancer screening. National
guidelines now include primary HPV screening every 5 years as an appropriate cervical cancer screening
strategy. Because HPV self-sampling in non-clinical settings has comparable accuracy to HPV-testing on
clinician-obtained samples, self-collection may represent an important strategy for increasing screening rates
among underscreened populations. In the United States, the provision of self-sampling kits improved screening
rates among women with limited resources and was highly acceptable. Notably, women reported experiencing
less embarrassment with self-sampling, and some studies found it improved subsequent participation in clinic-
based screening. Although prior studies have demonstrated that HPV self-sampling can be feasibly offered in
low-resource community settings, not one study has focused on underserved Asian American women, despite
the fact that this population has among the lowest cervical cancer screening rates. Therefore, the goal of the
proposed project is to examine HPV self-sampling in a community-based study of 800 Asian American women.
Using a matched-pair design, 12 community sites (n=400 women) will receive our previously tested community
education program on cervical cancer screening plus navigation, along with HPV self-sampling kits; and 12
community sites (n=400) will receive our previously tested community education program plus navigation to
clinic-based screening. The aims of the proposed project are to: (1) Compare rates of providing a self-collected
sample vs. obtaining clinic-based screening among 800 Asian American women; (2) Examine mediators of
participation; and (3) Assess the relative cost-effectiveness of HPV self-sampling vs. clinic-based screening.
Demographics, social/cultural environment, and physical environment factors will be assessed at baseline, post-
intervention, and 6-month follow-up. Participation in self-sampling or clinic-based screening will be assessed at 6-
month follow-up. The proposed project will be the first large-scale study to evaluate HPV self-sampling among
underserved Asian American women. Study findings will inform future evidence-based programs designed to
enhance screening participation among Asian American women nationally.