Cervical cancer is one of the few preventable forms of cancer, yet it still causes over 4,000 deaths in the US each year. Prevention and early detection could successfully eradicate the disease if practiced by the entire population. Most of the new cases of cervical cancer in the US are in women who have never been screened or have been screened infrequently. While most women in the US are screened for cervical cancer, pockets of the population remain unscreened or under-screened and are at risk of the disease. Homeless women are one of these pockets where cervical cancer still exerts a toll. Homeless women are screened for cervical cancer far less than all women, and even less than poor, housed women. The number of homeless women in the US is increasing, and these women will contribute more cases of cervical cancer unless effective methods to prevent new cases are developed. This research will identify the specific health and non-health aspects of cervical cancer screening that are important to homeless women in order to be screened. The study results will lead to the design of homeless-specific cervical cancer screening interventions to increase early detection among this unique population, and to prevent future cases of this disease. The proposed study will apply an innovative method of decision analysis to study individual choice in the context of cervical cancer screening. The approach uses a questionnaire to collect data on the choices people would make when faced with different combinations of factors that are important to a decision. For this study, we will first determine the relevant healh and non-health factors for the cervical cancer screening decision for homeless women, such as cost, location where the test is performed, the provider performing the test, etc. We will use this information to develop a survey including different screening scenarios that include these elements in different combinations. Homeless women recruited to the survey will choose between pairs of different combinations of screening scenarios to demonstrate their decision priorities. The resulting survey data will be analyzed to put numerical estimates on how important each element is to the choice to be screened for all homeless women in our study. The study findings will inform the design of screening interventions that can achieve the highest rate of screening for this particular population. What is preferred for homeless women may be different than that for housed, poor women, or for women of other incomes, etc. This research method allows strategies to be tailored to the preferences and desires of a particular group, to maximize the outcome of interest (in this case, screening). As an exploratory grant, our findings will be used to develop screening interventions for subsequent testing in controlled trials. This research will contribute to the NCI goal of cancer control and prevention, through early detection of disease.

Public Health Relevance

This research addresses cancer screening behavior in an under-screened population, homeless women. Our study will identify the relevant health and non-health decision factors that explain whether homeless women seek screening for cervical cancer, through a decision analytic method that examines choice. The ultimate goal of the research is to reduce cervical cancer morbidity and mortality among homeless women, and prevent cervical cancer in the US.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Psychosocial Risk and Disease Prevention Study Section (PRDP)
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Chollette, Veronica
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Harvard University
Public Health & Prev Medicine
Schools of Public Health
United States
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Wittenberg, Eve; Bharel, Monica; Bridges, John F P et al. (2016) Using Best-Worst Scaling to Understand Patient Priorities: A Case Example of Papanicolaou Tests for Homeless Women. Ann Fam Med 14:359-64
Wittenberg, Eve; Bharel, Monica; Saada, Adrianna et al. (2015) Measuring the Preferences of Homeless Women for Cervical Cancer Screening Interventions: Development of a Best-Worst Scaling Survey. Patient 8:455-67