Clinical Summary

• Nearly half of surveyed women experiencing homelessness were overdue for cervical cancer screening despite high willingness to participate.
• Community health worker-led education significantly improved cervical cancer knowledge scores.
• HPV self-sampling was accepted by a subset of participants and may help address structural barriers to screening.

Women experiencing homelessness face cervical cancer incidence and mortality rates up to 4 times higher than the US average, yet many remain underscreened because of barriers to healthcare access. An ongoing study led by researchers at Purdue University and presented at the 2026 Oncology Nursing Society (ONS) Congress is evaluating whether community health worker (CHW)-led education and human papillomavirus (HPV) self-sampling can improve screening participation in homeless shelters in Indiana.

The intervention is being implemented at 2 homeless shelters in Indianapolis and Lafayette. CHWs provide cervical cancer education followed by options for either standard screening navigation or HPV self-sampling, or both.

Researchers collected survey data from 212 participants aged 21 to 65 years. Nearly half (49%) were overdue for cervical cancer screening. Participants also reported high prevalence of known cervical cancer risk factors, including smoking and initiation of sexual activity before age 18.

Qualitative interviews with 30 participants identified multiple structural and psychosocial barriers to screening. Common concerns included transportation limitations, healthcare costs, fear of screening results, mistrust of healthcare providers, histories of sexual assault, and competing priorities associated with homelessness. Despite these challenges, interest in screening remained high. Eighty-four percent of participants said they wanted cervical cancer screening and believed it was important, while more than 94% reported at least some willingness to undergo screening.

In the second phase of the study, 145 participants completed one-on-one cervical cancer education sessions delivered by trained CHWs. Investigators reported that mean knowledge scores improved from 5.8 before education to 8.1 afterward, representing an average increase of 2.3 points.

Awareness of HPV self-sampling was limited before the intervention, with 77% reporting they had never heard of the approach. Among the 145 participants educated so far, 39 individuals (27%) chose HPV self-sampling, while 22 (15%) selected navigation to standard screening care.

The findings suggest that community-based education and alternative screening strategies may help address longstanding disparities in cervical cancer prevention among underserved populations. HPV self-sampling may be particularly relevant as national approvals expand for screening outside traditional clinical settings. CHWs may also play a critical role in building trust, improving education, and facilitating screening participation among women experiencing homelessness.

The investigators noted that the study “demonstrates the need for and willingness of PEH to participate in cervical cancer screening strategies that meet them where they are.” They added that HPV self-sampling in homeless shelters “can bridge critical gaps in cervical cancer screening for vulnerable populations.”

Source:

Tipton J, Rodriguez N. Exploring Feasibility and Acceptability of HPV Self-Sampling for Cervical Cancer Screening in Homeless Shelters. Presented at the Oncology Nursing Society Annual Congress; May 13-17, 2026. San Antonio, TX.