Subramanian Sujha, Kaganova Yevgeniya, Zhang Yuying, Hoover Sonja, Nyambe Namakau, Pinder Leeya, Chibwesha Carla, Kapambwe Sharon, Parham Groesbeck
RTI International, Waltham, MA, United States.
University of North Carolina, Lusaka, Zambia.
JMIR Res Protoc. 2018 Jul 25;7(7):e10429. doi: 10.2196/10429.
Although most countries in southern Africa have cervical cancer screening programs, these programs generally fail to reach a significant majority of women because they are often implemented as pilot or research projects, and this limits their scope and ability to scale up screening. Some countries have planned larger-scale programs, but these have either never been implemented or have not been successfully scaled up. Most of the global burden of cervical cancer is experienced in countries with limited resources, and mortality from cervical cancer is the most common cause of cancer-related deaths among women in Sub-Saharan Africa.
The purpose of this study is to learn about preferences for cervical cancer screening in Zambia, to identify barriers and facilitators for screening uptake, and to evaluate willingness to pay for screening services to support the scaling up of cervical cancer screening programs.
We will conduct a discrete choice experiment by interviewing women and men and asking them to choose among constructed scenarios with varying combinations of attributes relevant to cervical cancer screening. To inform the discrete choice experiment, we will conduct focus groups and interviews about general knowledge and attitudes about cervical screening, perception about the availability of screening, stigma associated with cancer and HIV, and payment for health care services. For the discrete choice experiment, we will have a maximum design of 120 choice sets divided into 15 sets of 8 tasks each with a sample size of 320-400 respondents. We will use a hierarchical Bayesian estimation procedure to assess attributes at the following two levels: group and individual levels.
The model will generate preferences for attributes to assess the most important features and allow for the assessment of differences among cohorts. We will conduct policy simulations reflecting potential changes in the attributes of the screening facilities and calculate the projected changes in preference for choosing to undergo cervical cancer screening. The findings from the discrete choice experiment will be supplemented with interviews, focus groups, and patient surveys to ensure a comprehensive and context-based interpretation of the results.
Because willingness to pay for cervical cancer screening has not been previously assessed, this will be a unique and important contribution to the literature. This study will take into account the high HIV prevalence in Sub-Saharan Africa and prevailing gender attitudes to identify an optimal package of interventions to reduce cervical cancer incidence. This simulation of women's decisions (and men's support) to undergo screening will lay the foundation for understanding the stated preferences and willingness to pay to help design future screening programs.
RR1-10.2196/10429.
尽管非洲南部的大多数国家都有宫颈癌筛查项目，但这些项目通常未能覆盖绝大多数女性，因为它们往往作为试点或研究项目实施，这限制了其规模和扩大筛查的能力。一些国家计划开展更大规模的项目，但这些项目要么从未实施，要么没有成功扩大规模。宫颈癌的全球负担主要集中在资源有限的国家，在撒哈拉以南非洲地区，宫颈癌死亡率是女性癌症相关死亡的最常见原因。
本研究旨在了解赞比亚女性对宫颈癌筛查的偏好，确定筛查接受率的障碍和促进因素，并评估为筛查服务付费以支持扩大宫颈癌筛查项目的意愿。
我们将通过访谈女性和男性进行离散选择实验，要求他们在具有不同宫颈癌筛查相关属性组合的构建场景中进行选择。为了为离散选择实验提供信息，我们将开展焦点小组讨论，并就宫颈癌筛查的一般知识和态度、对筛查可及性的认知、与癌症和艾滋病毒相关的耻辱感以及医疗保健服务付费情况进行访谈。对于离散选择实验，我们将采用最大设计，即120个选择集，分为15组，每组8个任务，样本量为320 - 400名受访者。我们将使用分层贝叶斯估计程序在以下两个层面评估属性：群体层面和个体层面。
该模型将生成对属性的偏好，以评估最重要的特征，并允许评估不同队列之间的差异。我们将进行政策模拟，反映筛查设施属性的潜在变化，并计算选择接受宫颈癌筛查的偏好预计变化。离散选择实验的结果将辅以访谈、焦点小组讨论和患者调查，以确保对结果进行全面且基于背景的解读。
由于此前尚未评估为宫颈癌筛查付费的意愿，这将是对文献的一项独特且重要的贡献。本研究将考虑撒哈拉以南非洲地区高艾滋病毒流行率以及普遍的性别态度，以确定一套最佳干预措施，降低宫颈癌发病率。这种对女性（以及男性支持）接受筛查决策的模拟将为理解既定偏好和付费意愿奠定基础，以帮助设计未来的筛查项目。
RR1 - 10.2196/10429
