Article Figures & Data
Figures
- Figure 1
Sample screen shot of a question from the survey.
Pap = Papanicolaou.
Note: Respondents were shown 11 questions similar to this, each with a different set of 5 attributes (ie, “objects,” predefined per the experimental design, so that each was seen 5 times and in combination with each other attribute twice during the course of the survey). They were instructed to choose which attribute would have the biggest influence on women’s decision to get tested, and which would have the smallest. A button appeared highlighted with color when it was “clicked.” After choosing biggest and smallest, respondents proceeded to the next question until completion of the 11 total sets.
- Figure 2
Standardized scores for the 11 hypothetical screening attributes.
Note: Standardized “biggest – smallest” scores and 95% confidence intervals for the 11 hypothetical screening attributes influencing homeless women’s decision to be tested. A total of 165 women participated, each of whom chose biggest and smallest attributes from 11 sets of 5 attributes each (3,630 total choices).
Tables
Characteristic Mean (SD) or No. (%) Age, y 43.1 (13.1) Racea White 69 (41.8) African American or black 57 (34.5) Native Hawaiian or Pacific Islander 1 (0.6) Other 20 (12.1) Multiple 4 (2.4) Hispanic onlyb 14 (8.5) Ethnicity: Latina/Hispanic 45 (27.3) Education <12 years 36 (21.8) High school diploma/GED 57 (34.5) Some college or college diploma 68 (41.2) Other type of degree/not sure 4 (2.4) Has childrenc 119 (72.6) Reported ≥1 medical condition 133 (80.6) Reported condition(s)d Depression/mental health condition 76 (46.1) Addiction 54 (32.7) High blood pressure 49 (29.7) Asthma/lung disease 46 (27.9) Liver disease/hepatitis C 30 (18.2) Diabetes 28 (17.0) Cancer 15 (9.1) Heart disease 8 (4.8) Another condition/disease 60 (36.4) Time since last Pap smear ≤12 months 103 (62.4) >12 months to ≤3 years 46 (27.9) >3 years 7 (4.2) Never had one 4 (2.4) Don’t know 5 (3.0) Questionnaire completion Spanish version 19 (11.5) Self-completed or some interviewer assistancee 91 (55.8) Time taken, min 13.2 (4.4) GED = General Educational Development Test; Pap = Papanicolaou.
Note: Percentages may not sum to 100 because of rounding.
↵a None reported Asian race.
↵b Indicated only ethnicity.
↵c Including children living elsewhere—data missing for 1 respondent.
↵d Of women reporting at least 1 condition.
↵e Data missing for 2 respondents.
- Table 2
Subjective Priority of Attributes Influencing Acceptance of Pap Smears Among Homeless Women: Frequency Counts and Standardized Score
Attribute No. of Times Chosen Standardized Scorea Biggest Influence Smallest Influence Support is available for all issues the woman is facing 370 51 0.39 Testing is done at no cost 277 96 0.22 Testing is not contingent on substance use 189 208 −0.02 Counseling is available to discuss results 182 72 0.13 Testing is done at convenient time 174 119 0.07 Choice of provider sex 169 178 −0.01 Time during procedure for questions/explanations 105 133 −0.03 Setting is accepting of homeless 104 231 −0.15 Provider is kind 88 156 −0.08 Personal hygiene accommodations 83 309 −0.27 Provider is familiar to woman 74 262 −0.23 Pap = Papanicolaou.
↵a Difference between count of chosen as biggest and count of chosen as smallest, divided by the number of times attribute was available to be selected per experimental design (for this design, 5 × number of respondents). Standardized scores indicate the salience of an attribute on a scale from −1.0 to +1.0. Scores toward +1.0 indicate salience as a biggest influence on testing, scores toward −1.0 indicate salience as a smallest influence on testing, and a score of 0 indicates no salience to the decision to undergo testing.
The Article in Brief
Using Best-Worst Scaling to Understand Patient Priorities: A Case Example of Papanicolaou Tests for Homeless Women
Eve Wittenberg , and colleagues
Background Best-Worst Scaling (BWS) is a survey method for assessing individuals' priorities: what is best and worst among a set of items. This report applies the BWS method to cervical cancer screening priorities for homeless women.
What This Study Found Best-Worst Scaling quantifies patients' priorities in a way that is transparent and accessible. To demonstrate the use of BWS in primary care, participants were asked to evaluate attributes of Pap services. The biggest influence on participants' decision about whether to have a Pap test was the availability of support for issues beyond health, followed by no-cost testing. Least important was the availability of accommodations for hygiene and participants' familiarity with the clinician.
Implications
- The authors conclude that BWS can be easily understood by patients and is relatively easy to administer. This approach can be applied to other areas of health care where prioritization is helpful in guiding decisions.
