title: Measuring the Preferences of Homeless Women for Cervical Cancer Screening Interventions: Development of a Best-Worst Scaling Survey.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA, 02115, USA. ewittenb@hsph.harvard.edu.
authors.forename: Eve
authors.initials: E
authors.lastname: Wittenberg
authors.affiliation: Boston Health Care for the Homeless Program, Boston, MA, USA.|Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.|Department of Medicine, Boston Medical Center, Boston, MA, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Bharel
authors.affiliation: Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA, 02115, USA.
authors.forename: Adrianna
authors.initials: A
authors.lastname: Saada
authors.affiliation: Boston Health Care for the Homeless Program, Boston, MA, USA.
authors.forename: Emely
authors.initials: E
authors.lastname: Santiago
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: John F P
authors.initials: JF
authors.lastname: Bridges
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Weinreb
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D054625:Healthcare Disparities; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D055815:Young Adult