Abstract
Objective
Despite having multiple risk factors, women experiencing homelessness are screened for cervical cancer at a lower rate than women in the general US population. We report on the design of a stated preference study to assess homeless women’s preferences for cervical cancer screening interventions, to inform efforts to overcome this disparity.
Methods
We conducted focus groups with homeless women (n = 8) on cervical cancer screening decisions and analyzed the data using thematic analysis. We applied inclusion criteria to select factors for a stated preference survey: importance to women, relevance to providers, feasibility, and consistency with clinical experience. We conducted pretests (n = 35) to assess survey procedures (functionality, recruitment, administration) and content (understanding, comprehension, wording/language, length).
Results
We chose best–worst scaling (BWS)—also known as object scaling—to identify decision-relevant screening intervention factors. We chose an experimental design with 11 “objects” (i.e., factors relevant to women’s screening decision) presented in 11 subsets of five objects each. Of 25 objects initially identified, we selected 11 for the BWS instrument: provider-related factors: attitude, familiarity, and gender; setting-related factors: acceptance and cost; procedure-related factors: explanation during visit and timing/convenience of visit; personal fears and barriers: concerns about hygiene, addiction, and delivery/fear of results; and a general factor of feeling overwhelmed.
Conclusion
Good practices for the development of stated preference surveys include considered assessment of the experimental design that is used and the preference factors that are included, and pretesting of the presentation format. We demonstrate the development of a BWS study of homeless women’s cervical cancer screening intervention preferences. Subsequent research will identify screening priorities to inform intervention design.
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Notes
In this paper, we use the term “attribute” to refer to preference components that are used in any stated preference instrument. We use the term “object” to refer to an attribute specifically in the context of best–worst scaling. We use the terms “decision factor” or “component” to refer to the elements that contribute to preferences in a general, nonexperimental context.
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Acknowledgments
The authors gratefully acknowledge the assistance of Erika Alvarez and Inez Adams, PhD, in conducting the focus groups; Zachary Ward, MPH, in survey formatting and programming; and Danielle Hollenbeck-Pringle, MPH, in data analysis and manuscript preparation. We also thank the organizations that generously allowed us to collect data from their guests and clients: the Boston Health Care for the Homeless Program, Pine Street Inn, Casa Esperanza, and Crittenton Women’s Union. Finally, we are most appreciative of the women who shared their views and experiences in our focus groups, without whom this research would have been impossible.
Funding source
The research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health, under Award Number R21CA164712. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding agreement guaranteed the authors’ independence in the research.
Preliminary results of this research were presented at the 35th Annual Meeting of the Society for Medical Decision Making; Baltimore, MD, USA; October 2013.
None of the authors have any conflicts to declare. E.W. and M.B. conceived of the study; L.W. provided guidance in its implementation; A.S. and E.S. participated in data collection; E.W. and A.S. conducted data analysis; and J.F.P.B. provided guidance in design. All authors participated in interpretation of the results. E.W. wrote the manuscript, and all authors reviewed and approved the final manuscript. E.W. serves as guarantor for the results.
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A Saada's and E Santiago's affiliation at the time that this research was conducted.
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Wittenberg, E., Bharel, M., Saada, A. et al. Measuring the Preferences of Homeless Women for Cervical Cancer Screening Interventions: Development of a Best–Worst Scaling Survey. Patient 8, 455–467 (2015). https://doi.org/10.1007/s40271-014-0110-z
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DOI: https://doi.org/10.1007/s40271-014-0110-z