Decision-making about cervical cancer screening methods by homeless women

To evaluate the perspectives and preferences of homeless women for traditional provider- and a novel low cost self-collected cytology screening technique, 17 interviews were conducted with women who participated in both phases of a comparative trial. Subjects were recruited from a comprehensive homeless service center and a residential program serving homeless women. Constructivist grounded theory guided data collection and analysis. Results showed self-collection was favored over provider-collected cytology, but that the women perceived that test accuracy trumped comfort. Although many women expressed inaccurate perceptions and beliefs about cervical cancer and screening, the women participated in and valued screening. Misconceptions about cervical malignancy and prevention strategies contributed to their complex appraisal of the two screening methods. Homeless women may partner with providers to develop and test effective interventions with high promise for improving their health and these insights may aid in developing effective interventions for diverse underserved communities.