Using Best-Worst Scaling to Understand Patient Priorities: A Case Example of Papanicolaou Tests for Homeless Women

Abstract

PURPOSE 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. METHODSWe 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. RESULTSIn 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).CONCLUSIONS 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. Ann Fam Med 2016;14:359-364. doi: 10.1370/afm.1937 and what is important for clinicians when deciding on treatments. 5 BWS belongs to the conjoint analysis family of methods, which collectively serve to identify preferences and trade-offs that contribute to individuals' choices with respect to "goods."6 These methods have been noted for their cognitive and administrative simplicity, 7 as well as their focus on the patient perspective. 8,9 In this article, we present the BWS method in the context of cervical cancer screening priorities for homeless women.Homeless women die from cervical cancer at a rate nearly 6 times that of the general population. 10 The rate of guideline-adherent screening among homeless women has been reported to be approximately 50%, compared with 82.8% of the insured US population and 61.9% of the uninsured population. METHODS ParticipantsWe recruited adult women experiencing homelessness in Boston, Massachusetts, from 5 sheltered settings: a homeless medical respite center; a health care for the homeless outpatient medical clinic; an emergency (ie, overnight) shelter; a transitional housing program; and a residential substance use treatment program. Inclusion criteria were being aged 18 years or older, verbally proficient in English or Spa...

Using Best-Worst Scaling to Understand the Preferences of Stroke Survivors, their Relatives/Carers and the Public on Providing Stroke Thrombectomy Services in England

“…All analyses were conducted in Stata version 15 [44] and Microsoft Excel [45]. In other BWS studies, standardised scores have been shown to provide similar information to regression coe cients from a conditional logistic regression model, but with a greater ease of both interpretation and calculation [46,47].…”

Perception of farmers about endometritis prevention and control measures for zero-grazed dairy cows on smallholder farms in Rwanda

“…All the recruited farmers were visited between September 2018 and April 2019. The study used the best-worst scaling (BWS) object case method to gather the perspectives of the farm owner about the effectiveness of MIs for endometritis prevention and control [21,59]. This approach has been used for livestock disease management in many countries [21,22,26].…”

Examining Generalizability of Older Adults’ Preferences for Discussing Cessation of Screening Colonoscopies in Older Adults with Low Health Literacy

“…BWS is a technique in which participants are presented with a list of objects and asked to choose the one object that they consider the best (most preferred) and the one object that they consider the worst (least preferred). [22][23][24] This allows for comparison of relative values across objects, something that is not possible with traditional Likert scale surveys. [22][23][24] As part of this technique, a subset of all objects is presented at a given time in a choice task and the participant completes a series of choice tasks where the objects in each task are systematically varied.…”

“…[22][23][24] This allows for comparison of relative values across objects, something that is not possible with traditional Likert scale surveys. [22][23][24] As part of this technique, a subset of all objects is presented at a given time in a choice task and the participant completes a series of choice tasks where the objects in each task are systematically varied. *At the beginning of the choice tasks, additional description was given that stated: "Sometimes, if the doctor does not think a person needs a screening colonoscopy, the doctor may not mention colon cancer screening at all" †At the beginning of the choice tasks, additional description was given that stated: "The doctor may tell a person that he does not need a colonoscopy without giving a reason"…”