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Grant Details

Grant Number: 3R01CA240375-03S1 Interpret this number
Primary Investigator: Buist, Diana
Organization: Kaiser Foundation Research Institute
Project Title: Self-Testing Options in the Era of Primary HPV Screening for Cervical Cancer: the Step Trial
Fiscal Year: 2021


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.

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