{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:57:30Z","timestamp":1792799850733,"version":"4.5.0"},"reference-count":34,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100002301","name":"Estonian Research Council","doi-asserted-by":"crossref","award":["No PRG722"],"award-info":[{"award-number":["No PRG722"]}],"id":[{"id":"10.13039\/501100002301","id-type":"DOI","asserted-by":"crossref"}]},{"name":"The Estonian Health Insurance Fund","id":[{"id":"https:\/\/ror.org\/04xrpfr88","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Med Screen"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical cancer incidence in Estonia ranks among the highest in Europe, but screening attendance has remained low. This randomized study aimed to evaluate the impact of opt-in and opt-out human papillomavirus (HPV) self-sampling options on participation in organized screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A random sample of 25,591 women were drawn from the cervical cancer screening target population who were due to receive a reminder in autumn 2021 and thereafter randomly allocated to two equally sized intervention arms (opt-out and opt-in) receiving a choice between HPV self-sampling or clinician sampling. In the opt-out arm, a self-sampler was sent to home address by regular mail; the opt-in arm received an e-mail containing a link to order a self-sampler online. The remaining 30,102 women in the control group received a standard reminder for conventional screening. Participation by intervention arm, age and region of residence was calculated; a questionnaire was used to assess self-sampling user experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A significant difference in participation was seen between opt-out (41.7%) (19.8% chose self-sampling and 21.9% clinician sampling), opt-in (34.1%) (7.9% self-sampling, 26.2% clinician sampling) and control group (29.0%, clinician sampling only). All age groups and regions in the intervention arms showed higher participation compared to the control group, but the size of the effect varied. Among self-sampling users, 99% agreed that the device was easy to use and only 3.5% preferred future testing at the clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Providing women with a choice between self-sampling and clinician sampling significantly increased participation in cervical cancer screening. Opt-in and opt-out options had a different effect across age groups, suggesting the need to adapt strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09691413241268819","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T01:15:21Z","timestamp":1722561321000},"page":"19-27","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["HPV self-sampling in organized cervical cancer screening program: A randomized pilot study in Estonia in 2021"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5319-4304","authenticated-orcid":false,"given":"Reeli","family":"Hallik","sequence":"first","affiliation":[{"name":"Institute of Clinical Medicine, University of Tartu, Tartu, Estonia"},{"name":"Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0120-2213","authenticated-orcid":false,"given":"Kaire","family":"Innos","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaak","family":"J\u00e4nes","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"J\u00f5ers","sequence":"additional","affiliation":[{"name":"United Laboratories of Tartu University Hospital, Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaspar","family":"Ratnik","sequence":"additional","affiliation":[{"name":"Synlab Estonia, Tallinn, Estonia"},{"name":"Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4769-0008","authenticated-orcid":false,"given":"Piret","family":"Veerus","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia"},{"name":"West-Tallinn Central Hospital Women's Clinic, Tallinn, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"bibr1-09691413241268819","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0215(20000501)86:3<440::AID-IJC22>3.0.CO;2-A"},{"key":"bibr2-09691413241268819","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2007.06.007"},{"key":"bibr3-09691413241268819","unstructured":"Statistic Estonia. 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