||3R01CA240375-03S1 Interpret this number
||Kaiser Foundation Research Institute
||Self-Testing Options in the Era of Primary HPV Screening for Cervical Cancer: the Step Trial
Title: Validity and Reliability of Survey Measures for Cervical Cancer Screening in the Redesigned
National Health Interview Survey (NHIS)
Measuring cervical cancer screening behavior in the U.S. helps public health professionals evaluate progress
towards the Healthy People goals and develop and evaluate interventions to increase appropriate screening
use. It also helps healthcare systems/providers determine if a cervical screening or surveillance regimen is
needed for new patients, which is critical to support outreach and quality metric activities. Comprehensively
assessing whether an woman has received appropriate screening requires multiple questions that probe on the
type of screening test (Pap alone, primary HPV, co-testing with Pap and HPV), time since and results of their
last test (normal, abnormal), and indication (screening or symptomatic). Ideally, similar cancer screening
history questions would be used by public health professionals and healthcare systems to facilitate comparable
measurement of screening trends over time. While several national surveys ask individuals about cancer
screening, there are no standard, validated, national set of questions for cervical cancer screening history.
Because past studies have shown lower validity among race/ethnic groups speaking different languages, it is
also critically important to evaluate if survey items are understood equivalently across groups and languages.
Soon, self-collected primary HPV screening will be added to the set of recommended modalities. In this
supplement, we propose conducting cognitive interviews with a purposive sample of diverse screening-eligible
adult women (e.g., by race/ethnicity, English/Spanish language preference, screening history) to further refine
National Health Interview Survey (NHIS) cancer screening questions that reflect the new recommended
guidelines and anticipate the expanded set of modalities. The goal of the cognitive interviews is to ensure
women have similar understanding of items and are willing to respond. We will: (1) use existing electronic data
from two healthcare systems (Harborview - U Washington, Parkland-UT Southwestern) that serve diverse
patient populations to identify screening-eligible individuals whom we can also characterize in terms of cancer
risk, socio-demographics, age, and prior screening history; (2) purposefully sample individuals based on known
characteristics to maximize efficiency in recruitment; and (3) employ a highly qualified team of epidemiologists,
qualitative researchers, and experts in cervical cancer and questionnaire design. After completing the cognitive
interviews and refining the questionnaire, a future study will further evaluate validity and reliability by
comparing responses to the gold standard (the patient’s electronic medical record) and survey responses over
time. Findings will also be shared with healthcare systems to advise on how to best ascertain screening history
among new patients.
None. See parent grant details.