Preferences for interventions designed to increase cervical screening uptake in non-attending young women: how findings from a discrete choice experiment compare with observed behaviours in a trial

Helen E. Campbell, Alastair M. Gray, Judith Watson, Cath Jackson, Carly Moseley, Margaret E. Cruickshank, Henry C. Kitchener, Oliver Rivero-Arias* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background

Young women’s attendance at cervical screening in the UK is continuing to fall, and the incidence of invasive cervical cancer is rising.

Objectives

We assessed the preferences of non‐attending young women for alternative ways of delivering cervical screening.

Design

Postal discrete choice experiment (DCE) conducted during the STRATEGIC study of interventions for increasing cervical screening uptake. Attributes included action required to arrange a test, location of the test, availability of a nurse navigator and cost to the National Health Service.

Setting and participants

Non‐attending young women in two UK regions.

Main outcome measures

Responses were analysed using a mixed multinomial logit model. A predictive analysis identified the most preferable strategy compared to current screening. Preferences from the DCE were compared with observed behaviours during the STRATEGIC trial.

Results

The DCE response rate was 5.5% (222/4000), and 94% of respondents agreed screening is important. Preference heterogeneity existed around attributes with strong evidence for test location. Relative to current screening, unsolicited self‐sampling kits for home use appeared most preferable. The STRATEGIC trial showed this same intervention to be most effective although many women who received it and were screened, attended for conventional cytology instead.

Conclusions

The DCE and trial identified the unsolicited self‐sampling kit as the most preferred/effective intervention. The DCE suggested that the decision of some women receiving the kit in the trial to attend for conventional cytology may be due to anxieties around home testing coupled with a knowledge that ignoring the kit could potentially have life‐changing consequences.

Original languageEnglish
JournalHealth Expectations
Early online date28 Oct 2019
DOIs
Publication statusE-pub ahead of print - 28 Oct 2019

Fingerprint

Cell Biology
National Health Programs
Uterine Cervical Neoplasms
Anxiety
Logistic Models
Nurses
Costs and Cost Analysis
Incidence
Surveys and Questionnaires

Keywords

  • cervical cancer
  • discrete choice experiments
  • heterogeneity
  • preferences
  • screening uptake
  • United Kingdom
  • young women

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Preferences for interventions designed to increase cervical screening uptake in non-attending young women : how findings from a discrete choice experiment compare with observed behaviours in a trial. / Campbell, Helen E.; Gray, Alastair M.; Watson, Judith; Jackson, Cath; Moseley, Carly; Cruickshank, Margaret E.; Kitchener, Henry C.; Rivero-Arias, Oliver (Corresponding Author).

In: Health Expectations, 28.10.2019.

Research output: Contribution to journalArticle

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title = "Preferences for interventions designed to increase cervical screening uptake in non-attending young women: how findings from a discrete choice experiment compare with observed behaviours in a trial",
abstract = "BackgroundYoung women’s attendance at cervical screening in the UK is continuing to fall, and the incidence of invasive cervical cancer is rising.ObjectivesWe assessed the preferences of non‐attending young women for alternative ways of delivering cervical screening.DesignPostal discrete choice experiment (DCE) conducted during the STRATEGIC study of interventions for increasing cervical screening uptake. Attributes included action required to arrange a test, location of the test, availability of a nurse navigator and cost to the National Health Service.Setting and participantsNon‐attending young women in two UK regions.Main outcome measuresResponses were analysed using a mixed multinomial logit model. A predictive analysis identified the most preferable strategy compared to current screening. Preferences from the DCE were compared with observed behaviours during the STRATEGIC trial.ResultsThe DCE response rate was 5.5{\%} (222/4000), and 94{\%} of respondents agreed screening is important. Preference heterogeneity existed around attributes with strong evidence for test location. Relative to current screening, unsolicited self‐sampling kits for home use appeared most preferable. The STRATEGIC trial showed this same intervention to be most effective although many women who received it and were screened, attended for conventional cytology instead.ConclusionsThe DCE and trial identified the unsolicited self‐sampling kit as the most preferred/effective intervention. The DCE suggested that the decision of some women receiving the kit in the trial to attend for conventional cytology may be due to anxieties around home testing coupled with a knowledge that ignoring the kit could potentially have life‐changing consequences.",
keywords = "cervical cancer, discrete choice experiments, heterogeneity, preferences, screening uptake, United Kingdom, young women",
author = "Campbell, {Helen E.} and Gray, {Alastair M.} and Judith Watson and Cath Jackson and Carly Moseley and Cruickshank, {Margaret E.} and Kitchener, {Henry C.} and Oliver Rivero-Arias",
note = "ACKNOWLEDGEMENTS We are grateful to Sara Rodgers and Laura Clark at the University of York for conducting the qualitative interviews. We are grateful to Maggie Redshaw at the National Perinatal Epidemiology Unit (NPEU) for helpful suggestions on how to improve the response rate in our study. We also would like to thank the NPEU design team who significantly improved the look of our final questionnaire, and the NPEU administration team for their assistance preparing the mail‐out material. Special thanks are given to our data entry team Sissi Hernandez‐Quesada, Jacob Stevens and Pamela White. We would also like to express our gratitude to the teams at the English and Scottish screening agencies for their willingness to collaborate in this study. Finally, we would like to thank all of the women who completed the DCE questionnaire and took part in the STRATEGIC trial; without them, this work would not have been possible.",
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AU - Watson, Judith

AU - Jackson, Cath

AU - Moseley, Carly

AU - Cruickshank, Margaret E.

AU - Kitchener, Henry C.

AU - Rivero-Arias, Oliver

N1 - ACKNOWLEDGEMENTS We are grateful to Sara Rodgers and Laura Clark at the University of York for conducting the qualitative interviews. We are grateful to Maggie Redshaw at the National Perinatal Epidemiology Unit (NPEU) for helpful suggestions on how to improve the response rate in our study. We also would like to thank the NPEU design team who significantly improved the look of our final questionnaire, and the NPEU administration team for their assistance preparing the mail‐out material. Special thanks are given to our data entry team Sissi Hernandez‐Quesada, Jacob Stevens and Pamela White. We would also like to express our gratitude to the teams at the English and Scottish screening agencies for their willingness to collaborate in this study. Finally, we would like to thank all of the women who completed the DCE questionnaire and took part in the STRATEGIC trial; without them, this work would not have been possible.

PY - 2019/10/28

Y1 - 2019/10/28

N2 - BackgroundYoung women’s attendance at cervical screening in the UK is continuing to fall, and the incidence of invasive cervical cancer is rising.ObjectivesWe assessed the preferences of non‐attending young women for alternative ways of delivering cervical screening.DesignPostal discrete choice experiment (DCE) conducted during the STRATEGIC study of interventions for increasing cervical screening uptake. Attributes included action required to arrange a test, location of the test, availability of a nurse navigator and cost to the National Health Service.Setting and participantsNon‐attending young women in two UK regions.Main outcome measuresResponses were analysed using a mixed multinomial logit model. A predictive analysis identified the most preferable strategy compared to current screening. Preferences from the DCE were compared with observed behaviours during the STRATEGIC trial.ResultsThe DCE response rate was 5.5% (222/4000), and 94% of respondents agreed screening is important. Preference heterogeneity existed around attributes with strong evidence for test location. Relative to current screening, unsolicited self‐sampling kits for home use appeared most preferable. The STRATEGIC trial showed this same intervention to be most effective although many women who received it and were screened, attended for conventional cytology instead.ConclusionsThe DCE and trial identified the unsolicited self‐sampling kit as the most preferred/effective intervention. The DCE suggested that the decision of some women receiving the kit in the trial to attend for conventional cytology may be due to anxieties around home testing coupled with a knowledge that ignoring the kit could potentially have life‐changing consequences.

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