Integrating behavioural science into HPV self-sampling and cervical cancer elimination strategies

Cervical cancer is highly preventable through regular screening and vaccination. The World Health Organization and governments worldwide have identified the elimination of cervical cancer as a public health problem, as an attainable goal, representing a major advancement in women’s health. While screening has traditionally relied on the Papanicolaou test (Pap test), evidence shows that HPV DNA testing is more accurate in detecting cervical precancers. HPV testing can be performed using clinician-collected or self-collected samples, with self-sampling shown to improve screening access and uptake across diverse populations (e.g., racial or ethnic minority persons, gender minority persons, newcomers) and settings (e.g., rural areas, geographically hard to reach). Despite this potential, several behavioural, structural, and system-level barriers continue to limit widespread uptake of HPV self-sampling. In this work, we argue that behavioural science is central to addressing these barriers. We apply the Capability, Opportunity, Motivation-Behaviour (COM-B) model to identify key barriers and propose multi-level, theory-informed strategies that span individuals, healthcare providers, and health systems to enhance the capability, opportunity, and motivation of women and people with a cervix (WPC) to engage in HPV self-sampling. Targeted education, coaching, strong provider-patient engagement, accessible kit distribution and return pathways, and meaningful community involvement may collectively strengthen uptake of HPV self-sampling and accelerate progress toward global cervical cancer elimination.