Development of an HPV stigma assessment scale and a stigma-reducing intervention to improve cervical cancer prevention in El Salvador

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA23-036”. Cervical cancer is a leading cause of cancer death for women in low and middle income countries (LMICs). Women often experience distress, fear, and shame associated with cervical cancer screening, but there is a lack of validated psychometric assessments that measure cervical cancer or HPV-related stigma. Internalized and anticipated stigma from partners, community members, or healthcare providers have been shown to reduce health-seeking behaviors in other health conditions, and it is likely that cervical cancer and HPV-related stigma impact screening rates in LMICs even when screening is offered. In El Salvador, up to 30% of women invited to screening do not attend. Thus, there is an urgent need to better understand and measure how HPV stigma is understood and manifested, and to design interventions that can reduce HPV-related stigma and increase uptake of cervical cancer preventive services. The purpose of this Administrative Supplement is to adapt an existing psychometric tool to assess HPV stigma and to design a pilot-ready stigmareducing “brief intervention”. This proposal is aligned with the parent grant, which will clinically validate a new HPV test for use in LMICs. This Supplement will focus on the following Specific Aims: 1) Adapt the Berger Stigma Scale (BSS) to HPV and abridge it for use in El Salvador and other LMIC settings, 2) Conduct a mixedmethods formative assessment of cervical cancer and HPV-related stigma in the context of El Salvador's cervical cancer prevention program, and 3) Design a pilot-ready brief intervention (BI) to reduce HPV-related stigma and increase adherence in El Salvador cervical cancer prevention program. Milestones for this project will be a validated, short-form scale to assess HPV-related stigma in LMICs and a completed “brief intervention” protocol that is ready for testing. We plan to seek subsequent funding to test intervention efficacy. We have the tools to eliminate cervical cancer in our lifetime, but there is a critical need for improved strategies to implement vaccination, screening, and treatment efforts. Identifying and measuring HPV-related stigma is a necessary step to reduce barriers and increase adoption of cervical cancer prevention and to close the unacceptable gap in global cervical cancer incidence and mortality.