Predictors of Intention to Use At-Home HPV Testing: Health Belief Factors and Potential Moderation by Decision-Making Style.

BACKGROUND Cervical cancer screening rates are declining in the United States and below the Healthy People 2030 goal of 79.2%. Alternative screening methods to the Pap test (e.g., at-home human papilloma virus [HPV] testing) need to be explored to determine if they are feasible for those unscreened and underscreened. The purpose of this study was to determine the relative importance of Health Belief Model constructs on intention to use at-home HPV testing and explore possible moderation by a person's decision-making style.

METHODS A total of 300 women aged 30-65 in the United States were recruited via a survey panel, Prolific, to complete an online survey assessing their decision-making styles (analytic or intuitive), relative importance of various health beliefs, and intention to use at-home HPV testing, if such an option were available to them. Constructs of the Health Belief Model were included as predictors of intention in a regression model, with decision-making styles included as potential moderators of the relative importance.

RESULTS Participants' mean age was 40.9 ± 8.9; most were white (79.3%) and had graduated college (66.3%). The mean intention to use at-home HPV testing score was 3.9 (standard deviation = 1.1) out of 5, indicating generally positive agreement. Perceived general benefits, cues to action with family and friends, and self-efficacy related to the test were significantly positively associated with intention, whereas misunderstanding related to need for HPV testing was negatively associated with intention. Self-efficacy was the strongest predictor (β = .69, p < .001). Neither decision-making style was significantly associated with the outcome and there was no evidence of moderation.

CONCLUSIONS As self-efficacy related to at-home HPV testing is the strongest predictor of intention to use it, effective messaging that ensures users' self-efficacy and confidence in their ability to correctly complete the test is needed.