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

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. 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. 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. Our results thus advocate for tailored screening programs.