Screen Your Way Study Protocol: Cervical screening via Human Papillomavirus (HPV) self-collection for Aboriginal and Torres Strait Islander women and people with a cervix

This implementation study aims to embed Human Papillomavirus (HPV) self-collection into usual care as part of the National Cervical Screening Program within Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHO) and/or primary care organisations whose context is similar to that of an ACCHO. This will be achieved by co-designing, implementing, and evaluating models of care tailored to local needs. ACCHOs will be recruited to participate in this before and after implementation study. After recruitment to the study, strategies will be co-designed with each service tailored to meet local needs and then implemented by the service as part of usual primary care as part of the National Cervical Screening Program for 12 months. The research team will work with nominated staff at participating services to facilitate co-design workshops, the design of locally tailored strategies and to engage with community members as determined locally in line with keys principles of co-design with Aboriginal and Torres Strait Islander peoples including leadership, a culturally grounded approach, respect, benefit to community, inclusive partnerships and transparency and evaluation and reciprocity. Co-design occurred over a period of up to 6 months prior to implementation and varied based on local service needs, capacities, and community priorities. Each participating site has co-designed and will implement locally tailored strategies to improve cervical screening participation among Aboriginal and Torres Strait Islander women and people with a cervix. These strategies reflect community priorities and service capacities, and were developed collaboratively between health services, community members, and the research team. Rather than being prescriptive, the strategies are designed to enhance usual clinical care and allow each service to select and adapt approaches that best suit their local context. This includes choosing from a suite of options based on identified needs, existing resources, and community preferences. The flexible design ensures that HPV self-collection is embedded into routine care sustainably. Examples of strategies include: 1. Community engagement strategies a. Community awareness campaigns: Co-designed posters, brochures, and social media content developed jointly by service staff and the research team. These materials promote the choice of HPV self-collection directly to ACCHO clients. b. Health promotion: Community events and campaigns hosted by ACCHO to raise awareness of HPV self-collection and provide education, and encourage clients to participate in cervical screening. 2. Participant level strategies a. Follow-up reminders: Modification of SMS or phone call reminders for clients who are due for cervical screening with the offer of self-collection. b. Incentives: Participants who complete cervical screening are offered a small incentive, such as a gift card or wellbeing pack, to acknowledge their participation and encourage uptake. Incentives are provided immediately after screening by service staff, either during consultations or at community events. 3. Workforce level strategies a. Staff education and training: Delivered by the research team, these sessions cover cervical screening guidelines, self-collection procedures, and communication strategies for ACCHO clients. Training is provided in-person or online depending on site needs. b. Clinical champions: Identified within each service to support implementation, mentor staff, and liaise with the research team. 4. Health service level strategies: a. Data Audit and Cleaning: Practice staff and/or research support teams conduct detailed audits of cervical screening data within practice management software to identify eligible participants and ensure data accuracy. This process involves checking individual client records against the National Cancer Screening Register (NCSR) and manually updating local records where discrepancies are found. The aim is to create a reliable and up-to-date screening register within each service, which supports targeted outreach and follow-up, and ensures that screening invitations are based on accurate information. b. Workflow Integration: Services have integrated cervical screening checks into routine clinical workflows to promote opportunistic screening. This includes embedding prompts into appointment systems and clinical templates to ensure that cervical screening status is reviewed and self-collection is offered during regular visits, such as 715 health checks or chronic disease reviews. Staff are encouraged to offer screening as part of everyday care, supported by incentives for participants and streamlined documentation processes to reduce administrative burden and improve uptake.