Implementing HPV self-collection: a scoping review of facilitators and strategies among Indigenous women and people with a cervix

Indigenous peoples in high-income settler-colonial countries experience disproportionately high cervical cancer incidence and mortality compared to non-Indigenous populations, reflecting systemic inequities and barriers to culturally safe care. HPV self-collection offers a potential solution to overcoming inequities by enabling women and people with a cervix to collect their own sample, improving autonomy, privacy, and access, and supporting culturally responsive models of care. While self-collection is accurate, acceptable, and increases screening participation, evidence is needed on how best to support implementation to reach Indigenous women and people with a cervix. This scoping review aimed to identify and describe implementation strategies, barriers, facilitators, and context-specific adaptations to HPV self-collection for cervical screening among Indigenous women and people with a cervix in high-income settler colonial countries. Eligible sources included peer-reviewed and grey literature published between August 2013 and November 2025 that described barriers, facilitators, implementation strategies, or context-specific adaptations to HPV self-collection among Indigenous women and people with a cervix in Australia, Aotearoa New Zealand, Canada, or the United States of America (USA). Database (PubMed, SCOPUS, ProQuest CINAHL) and grey literature searches targeting Indigenous-specific organisations, government websites were conducted, using the broad search terms: cervical screening, HPV, self-collection, and Indigenous peoples. Data were extracted and mapped against the Health Equity Implementation Framework to identify barriers, facilitators, and strategies relevant to the implementation of HPV self-collection. 32 publications were included, comprising 28 academic publications and 4 from the grey literature. Identified facilitators included client health literacy and knowledge, flexible models of care, culturally responsive care, supportive data and systems, and strengths-based messaging. Indigenous-led solutions were central to enabling these facilitators. While evidence comparing the impact of individual strategies is not available, community-driven, multi-component strategies were recommended. The most effective strategies appeared to combine flexible delivery models, such as home-based or outreach approaches, with tailored education focusing on increasing knowledge and building trust. Indigenous-led approaches and the involvement of Indigenous health workers and community leaders were central to strategies.