Women's preferences for HPV self-sampling in cervical cancer screening: a discrete choice experiment

HPV self-sampling can increase cervical cancer screening coverage. To effectively implement this innovative screening method, it is crucial to gain an in-depth understanding of women's acceptance and preferences regarding each stage of the HPV self-sampling intervention process. This study aims to identify the key attributes of HPV self-sampling that drive acceptance among under-screened populations, thereby informing the development of equitable screening strategies that reduce barriers and expand access to cervical cancer prevention.

In this cross-sectional study, we conducted a Discrete Choice Experiment (DCE) between 1 September 2024 and 31 March 2025, assessing preferences for five attributes of HPV self-sampling: accuracy, procedural difficulty, comfort, sampling time, and price. Analyses employed a mixed logit model, adhering to the Discrete Choice Experiment Reporting Checklist (DIRECT) reporting guideline. We estimated relative importance (RI) for each attribute, derived willingness-to-pay (WTP), and examined preference heterogeneity using interaction terms.

Of 200 valid responses, accuracy carried the greatest weight (RI 42.55%), followed by price (20.67%), sampling time (13.66%), procedural difficulty (11.68%), and comfort (11.45%). Low accuracy markedly reduced acceptance (β = -6.640, p < 0.001), as did higher price (β = -0.011, p < 0.001) and longer sampling time (>5 min; β = -1.703, p < 0.001). Participants showed a positive preference for more difficult procedures (β = 1.550, p < 0.01), and moderate comfort increased acceptance (β = 1.192, p < 0.001). Preference heterogeneity was observed: older age was associated with less aversion to low accuracy (β = 0.190, p < 0.001), greater tolerance of procedural difficulty (β = 0.106, p < 0.01), and a higher preference for moderate comfort (β = 0.037, p < 0.05). Ethnic minorities were less averse to low accuracy than Han respondents (β = 3.085, p < 0.01). Higher education was associated with a lower preference for moderate comfort (β = -0.375, p < 0.05). Women already inclined towards self-sampling were more averse to low accuracy (β = -2.623, p < 0.001) and procedural difficulty (β = -1.095, p < 0.05).

Accuracy, price, and sampling time are the dominant drivers of women's choices for HPV self-sampling, and are simultaneously significantly moderated by individual characteristics such as age, ethnicity, education, and sampling preference. These findings underscore that effective screening programs must not only optimize core product attributes but also develop tailored strategies to address the distinct preferences of different demographic subgroups.