Measuring the Preferences of Homeless Women for Cervical Cancer Screening Interventions: Development of a Best-Worst Scaling Survey

Patient. 2015 Oct;8(5):455-67. doi: 10.1007/s40271-014-0110-z.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Early Detection of Cancer / methods
  • Early Detection of Cancer / psychology
  • Early Detection of Cancer / statistics & numerical data
  • Female
  • Focus Groups
  • Healthcare Disparities
  • Homeless Persons / psychology*
  • Humans
  • Mass Screening / methods
  • Mass Screening / psychology
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Papanicolaou Test / methods
  • Papanicolaou Test / psychology*
  • Papanicolaou Test / statistics & numerical data
  • Patient Acceptance of Health Care / psychology*
  • Patient Acceptance of Health Care / statistics & numerical data
  • Patient Preference / psychology*
  • Patient Preference / statistics & numerical data
  • United States
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / prevention & control
  • Young Adult