Women’s preferences for cervical cancer screening methods: a discrete choice experiment in Estonia and France

Background This study explores women's preferences for cervical cancer screening (CCS) in Estonia and France, particularly preferences for self-sampling (SS). Although many European countries have introduced organized CCS, screening behaviours still exhibit a strong social gradient, with CC disproportionately affecting populations facing barriers to access, such as low income, rural residence, migration status or low education. The WHO has set a goal of eliminating CC and has proposed different strategies of invitations, outreach campaigns and the introduction of SS as a potential lever to increase uptake. Methods To assess whether these CCS strategies align with women's preferences, we conducted a discrete choice experiment (DCE) in Estonia and France. Pooling our data (N = 4774), we used a two-stage decision-making framework; first, intervention preferences were assessed, and then the willingness to participate if preferred interventions were implemented was measured. We also conducted a heterogeneity analysis via latent class analysis. The DCE has three attributes: invitation methods, sampling methods (physician-based sampling or self-sampling), and awareness-raising campaigns. The results were analysed using a mixed multinomial logit model to capture heterogeneity in preferences and explore factors influencing CCS participation. Results The results show that the implementation of SS would: 1) increase uptake among women facing geographical barriers to CCS, 2) help engage first-time screeners in a screening pathway and 3) possibly deter participation from women already engaged in their screening pathway if implemented as sole mean of screening. Conclusions Our results thus advocate for tailored screening programs.