Protocol to measure validity and reliability of colorectal, breast, cervical and lung cancer screening questions - Methodology and design

Sep 21, 2026

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Previous research shows high concordance between self-reported breast cancer mammography and colorectal cancer colonoscopy screening versus electronic medical records (EMRs), with adherence to screening guidelines and strong sensitivity and specificity. Concordance is lower for cervical and lung cancer screening, with poorer sensitivity or specificity across some sub-populations. The protocol describes a study to measure the validity and reliability of lung, colorectal, cervical, and breast cancer screening questions from the 2021 and 2022 National Health Interview Survey, compared with EMRs from four U.S. healthcare systems.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages17

Reading Time43 min

AccessFree to download

Abstract

Study Protocol

Protocol overview and objectives

Planned randomized phone-vs-web survey

Validity and reliability evaluation metrics

Introduction

PLOS ONE OPEN ACCESS Citation: Kessler LG, Comstock B, Aiello Bowles EJ, Mou J, Nash MG, Bravo P, et al. (2024) Protocol to measure validity and reliability of colorectal, breast, cervical and lung cancer screening questions from the 2021 National Health Interview Survey: Methodology and design. PLoSONE 19(3): e0297773 . [https://doi.org/10.1371/](https://doi.org/10.1371/)[ ](https://doi.org/10.1371/)[journal.pone.0297773](journal.pone.0297773) Editor: Eugenio Paci, Centro per lo Studio e la Prevenzione Oncologica, ITALY Received: December 21, 2023 Accepted: January 10, 2024 Published: March 4, 2024 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: [https://doi.org/10.1371/journal.pone.0297773](https://doi.org/10.1371/journal.pone.0297773) [Copyright:](Copyright:) © [2024](2024) Kessler et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: No datasets were generated or analysed during the current study. All STUDY PROTOCOL Protocol to measure validity and reliability of colorectal, breast, cervical and lung cancer screening questions from the 2021 National Health Interview Survey: Methodology and design Larry G. Kessler1 *, Bryan Comstock2, Erin J. Aiello Bowles3, Jin Mou4, Michael G. Nash2, Perla Bravo1, Lynn E. Fleckenstein3, Chaya Pflugeisen4, Hongyuan Gao3, Rachel L. Winer5, India J. Ornelas1, Cynthia Smith4, Chris Neslund-Dudas6, Punith Shetty6 1 Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America, 2 Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, United States of America, 3 Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America, 4 Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington, United State of America, 5 Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America, 6 Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, United States of America * [kesslerl@uw.edu](kesslerl@uw.edu) Abstract Previous studies demonstrate that self-reports of mammography screening for breast cancer and colonoscopy screening for colorectal cancer demonstrate concordance, based on adherence to screening guidelines, with electronic medical records (EMRs) in over 90% of those interviewed, as well as high sensitivity and specificity, and can be used for monitoring our Healthy People goals. However, for screening tests for cervical and lung cancers, and for various sub-populations , concordance between self-report and EMRs has been noticeably lower with poor sensitivity or specificity. This study aims to test the validity and reliability of lung, colorectal, cervical, and breast cancer screening questions from the 2021 and 2022 National Health Interview Survey (NHIS) . We present the protocol for a study designed to measure the validity and reliability of the NHIS cancer screening questions compared to EMRs from four US-based healthcare systems. We planned a randomized trial of a phone-vs web-based survey with NHIS questions that were previously revised based on extensive cognitive interviewing. Our planned sample size will be 1576 validity interviews, and 1260 interviews randomly assigned at 1 or 3 months after the initial interview. We are enrolling people eligible for cancer screening based on age, sex, and smoking history

FAQs

What is the main objective of the study protocol?

To measure the validity and reliability of lung, colorectal, cervical, and breast cancer screening questions drawn from the 2021 and 2022 National Health Interview Survey by comparing them with EMRs.

How will validity be evaluated in the study?

Validity will be assessed using concordance, sensitivity, specificity, positive predictive value, negative predictive value, and the report-to-records ratio.

How will reliability of the screening questions be tested?

Participants will complete a second survey either 1 or 3 months later, enabling evaluation of question reliability over time.

Sep 21, 2026

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