title: Using Best-Worst Scaling to Understand Patient Priorities: A Case Example of Papanicolaou Tests for Homeless Women.
abstract: Best-worst scaling (BWS) is a survey method for assessing individuals' priorities. It identifies the extremes-best and worst items, most and least important factors, biggest and smallest influences-among sets. In this article, we demonstrate an application of BWS in a primary care setting to illustrate its use in identifying patient priorities for services.
  
  
  
  We conducted a BWS survey in 2014 in Boston, Massachusetts, to assess the relative importance of 10 previously identified attributes of Papanicolaou (Pap) testing services among women experiencing homelessness. Women were asked to evaluate 11 sets of 5 attributes of Pap services, and identify which attribute among each set would have the biggest and smallest influence on promoting uptake. We show how frequency analysis can be used to analyze results.
  
  
  
  In all, 165 women participated, a response rate of 72%. We identified the most and least salient influences on encouraging Pap screening based on their frequency of report among our sample, with possible standardized scores ranging from+1.0 (biggest influence) to -1.0 (smallest influence). Most important was the availability of support for issues beyond health (+0.39), while least important was the availability of accommodations for personal hygiene (-0.27).
  
  
  
  BWS quantifies patient priorities in a manner that is transparent and accessible. It is easily comprehendible by patients and relatively easy to administer. Our application illustrates its use in a vulnerable population, showing that factors beyond those typically provided in health care settings are highly important to women in seeking Pap screening. This approach can be applied to other health care services where prioritization is helpful to guide decisions.
authors.affiliation: Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts ewittenb@hsph.harvard.edu.
authors.forename: Eve
authors.initials: E
authors.lastname: Wittenberg
authors.affiliation: The Boston Health Care for the Homeless Program, and Department of Medicine, Massachusetts General Hospital and Boston Medical Center, Boston, Massachusetts; currently: Department of Public Health, Commonwealth of Massachusetts, Boston, Massachusetts.
authors.forename: Monica
authors.initials: M
authors.lastname: Bharel
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: John F P
authors.initials: JF
authors.lastname: Bridges
authors.affiliation: Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Ward
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Linda
authors.initials: L
authors.lastname: Weinreb
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test / Q000191:economics / Q000523:psychology*; D011320:Primary Health Care; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: best-worst scaling; cervical cancer; conjoint analysis; homeless; methods; stated preferences; vulnerable populations