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Meta-Analysis
. 2011 May 11;2011(5):CD002834.
doi: 10.1002/14651858.CD002834.pub2.

Interventions targeted at women to encourage the uptake of cervical screening

Thomas Everett  1 , Andrew Bryant, Michelle F Griffin, Pierre Pl Martin-Hirsch, Carol A Forbes, Ruth G Jepson
Affiliations
Meta-Analysis

Interventions targeted at women to encourage the uptake of cervical screening

Thomas Everett et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: World-wide, cervical cancer is the second most common cancer in women. Increasing the uptake of screening, alongside increasing informed choice is of great importance in controlling this disease through prevention and early detection.

Objectives: To assess the effectiveness of interventions aimed at women, to increase the uptake, including informed uptake, of cervical cancer screening.

Search strategy: We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Issue 1, 2009. MEDLINE, EMBASE and LILACS databases up to March 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.

Selection criteria: Randomised controlled trials (RCTs) of interventions to increase uptake/informed uptake of cervical cancer screening.

Data collection and analysis: Two review authors independently abstracted data and assessed risk of bias. Where possible the data were synthesised in a meta-analysis.

Main results: Thirty-eight trials met our inclusion criteria. These trials assessed the effectiveness of invitational and educational interventions, counselling, risk factor assessment and procedural interventions. Heterogeneity between trials limited statistical pooling of data. Overall, however, invitations appear to be effective methods of increasing uptake. In addition, there is limited evidence to support the use of educational materials. Secondary outcomes including cost data were incompletely documented so evidence was limited. Most trials were at moderate risk of bias. Informed uptake of cervical screening was not reported in any trials.

Authors' conclusions: There is evidence to support the use of invitation letters to increase the uptake of cervical screening. There is limited evidence to support educational interventions but it is unclear what format is most effective. The majority of the studies are from developed countries and so the relevance to developing countries is unclear.

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Conflict of interest statement

No known conflict of interest.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Funnel plot of comparison: 1 Invitation vs control, outcome: 1.1 Uptake of screening.
1.1
1.1. Analysis
Comparison 1 Invitation vs control, Outcome 1 Uptake of screening.
2.1
2.1. Analysis
Comparison 2 GP invitation letter vs invitation letter from other authority sources, Outcome 1 Uptake of screening.
3.1
3.1. Analysis
Comparison 3 Personal invitation vs invitation letter, Outcome 1 Uptake of screening.
4.1
4.1. Analysis
Comparison 4 Letter with fixed appointment vs letter with open invitation to make an appointment, Outcome 1 Uptake of screening.
5.1
5.1. Analysis
Comparison 5 Education vs control, Outcome 1 Uptake of screening.
6.1
6.1. Analysis
Comparison 6 Education vs other, Outcome 1 Uptake of screening.
6.2
6.2. Analysis
Comparison 6 Education vs other, Outcome 2 Lay health outreach worker and media education vs media education.
6.3
6.3. Analysis
Comparison 6 Education vs other, Outcome 3 Standard invitation and printed education vs standard invitation.
7.1
7.1. Analysis
Comparison 7 Counselling vs control, Outcome 1 Uptake of screening.
8.1
8.1. Analysis
Comparison 8 Counselling vs other, Outcome 1 Uptake of screening.
9.1
9.1. Analysis
Comparison 9 Enhanced risk assessment vs control, Outcome 1 Uptake of screening.
10.1
10.1. Analysis
Comparison 10 Enhanced risk assessment vs other, Outcome 1 Uptake of screening.
11.1
11.1. Analysis
Comparison 11 Access to health promotion nurse vs control, Outcome 1 Uptake of screening.
12.1
12.1. Analysis
Comparison 12 Photocomic vs placebo comic, Outcome 1 Uptake of screening.
13.1
13.1. Analysis
Comparison 13 Intensive recruitment attempts vs control, Outcome 1 Uptake of screening.
14.1
14.1. Analysis
Comparison 14 Message framing, Outcome 1 Gain versus loss message framing (Detection).
14.2
14.2. Analysis
Comparison 14 Message framing, Outcome 2 Gain versus loss message framing (Prevention).
14.3
14.3. Analysis
Comparison 14 Message framing, Outcome 3 Gain Message Framing: Prevention vs Detection.
14.4
14.4. Analysis
Comparison 14 Message framing, Outcome 4 Loss Message Framing: Prevention vs Detection.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Byles 1996 {published and unpublished data}
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Eaker 2004 {published data only}
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Greene 1999 {published data only}
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Hunt 1998 {published and unpublished data}
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Lancaster 1992 {published data only (unpublished sought but not used)}
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McAvoy 1991 {published data only (unpublished sought but not used)}
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McDowell 1989 {published and unpublished data}
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Mock 2007 {published data only}
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Morrell 2005 {published data only}
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Navarro 1995 {published data only (unpublished sought but not used)}
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Ornstein 1991 {published and unpublished data}
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Oscarsson 2007 {published data only}
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Pierce 1989 {published and unpublished data}
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Pritchard 1995 {published and unpublished data}
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Rimer 1999 {published data only (unpublished sought but not used)}
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Risi 2004 {published data only}
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Rivers 2005 {published data only}
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Stein 2005 {published data only}
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Sung 1997 {published data only (unpublished sought but not used)}
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Taylor 2002 {published data only}
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Vogt 2003 {published data only}
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Wilson 1987 {published and unpublished data}
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References to studies excluded from this review

Al Saifafi 2009 {published data only}
    1. Al Sairafi, Mohamed FA. Knowledge, attitudes, and practice related to cervical cancer screening among Kuwaiti women. Medical Principles and Practice 2009;18(1):35‐42. - PubMed
Baele 1998 {published data only}
    1. Baele J. The influence of a home‐visit on the participation of Moroccan and Spanish women in cervical cancer screening: an intervention study [De invloed van een huisbezoek op de participatie van Marokkaanse en Spaanse vrouwen aan een bevolkigsonderzoek naar baarmoederhalskanker in Vlaams‐Brabant. Een interventiestudie]. Tijdschrift voor Sociale Gezondheidszorg 1998;76:374‐80.
Boissel 1995 {published data only}
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Bonevski 1999 {published data only}
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Brewster 2002 {published data only}
    1. Brewster WR, Anton Culver H, Ziogas A, Largent J, Howe S, et al. Recruitment strategies for cervical cancer prevention study. Gynecologic Oncology 2002;85(2):250‐4. - PubMed
Campbell 1997 {published data only}
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Cecchini 1989 {published data only}
    1. Cecchini S, Grazzini G, Bartoli D, Falvo I, Ciatto S. An attempt to increase compliance to cervical cancer screening through general practitioners. Tumori 1989;75(6):615‐18. - PubMed
Chumworathayi 2007 {published data only}
    1. Chumworathayi B, Yuenyao P, Luanratanakorn S, Pattamadilok J, Chalapati W, Na‐Nhongkai C. Can an appointment‐letter intervention increase pap smear screening in Samliem, Khon Kaen, Thailand?. Asian Pacific Journal of Cancer Prevention: Apjcp 2007;8(3):353‐6. - PubMed
Corkrey 2005 {published data only}
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Del Mar 1995 {published data only}
    1. Mar CB, Wright RG. Notifying women of the results of their cervical smear tests by mail: does it result in a decreased loss to follow‐up of abnormal smears.. Australian Journal of Public Health 1995;19(2):211‐13. - PubMed
Dignan 1996 {published data only (unpublished sought but not used)}
    1. Dignan M, Michielutte R, Blinson K, Wells HB, Case LD, Sharp P, et al. Effectiveness of health education to increase screening for cervical cancer among eastern‐band Cherokee Indian women in North Carolina. Journal of the National Cancer Institute 1996;88(22):1670‐6. - PubMed
Dignan 1998 {published data only (unpublished sought but not used)}
    1. Dignan MB, Michielutte R, Wells BH, Sharp P, Blinson K, Case LD, et al. Health education to increase screening for cervical cancer among Lumbee Indian women in North Carolina. Health Education Research 1998;13(4):545‐56. - PubMed
Engelstad 2005 {published data only}
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German 1995 {published and unpublished data}
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Gotay 2000 {published data only}
    1. Gotay CC, Banner RO, Matsunaga DS, Hedlund N, Enos R, Issell BF, DeCambra H. Impact of a culturally appropriate intervention on breast and cervical screening among native Hawaiian women. Preventive Medicine 2000;31(5):529‐37. - PubMed
Hancock 2001 {published data only}
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Hicks 1997 {published and unpublished data}
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Hillman 1998 {published data only}
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Holloway 2003 {published data only}
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Hou 2002 {published data only}
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Hou 2005 {published data only}
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Jenkins 1999 {published data only}
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Karwalajtys 2007 {published data only}
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Katz 2007 {published data only}
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Lam 2003 {published data only}
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Lantz 1995 {published and unpublished data}
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Lantz 1996 {published data only}
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Lauver 1990 {published data only}
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Litzelman 1993 {published data only}
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Lynch 2004 {published data only}
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Manfredi 1998 {published data only}
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Marcus 1992 {published data only (unpublished sought but not used)}
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Marcus 1998 {published data only}
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Margolis 1998 {published data only (unpublished sought but not used)}
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Maxwell 2003 {published data only}
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Mayer 1992 {published data only}
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Miller 1999 {published data only}
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Miller 2007 {published data only}
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Mitchell 1991 {published data only}
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Mitchell 1997 {published data only}
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Newell 2002 {published data only}
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Nguyen 2000 {published data only}
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Park 2005 {published data only}
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Paskett 1990 {published and unpublished data}
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Paskett 1995 {published data only}
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Paskett 1999 {published data only}
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Paul 2003 {published data only}
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Perkins 2007 {published data only}
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Peters 1999 {published data only (unpublished sought but not used)}
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Philips 2006 {published data only}
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Powers 1992 {published data only}
    1. Powers RL, Shumway JM. Written patient reminders improve cancer screening practices. Clinical Research 1992;40(2):A610.
Roetzheim 2004 {published data only}
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Roetzheim 2005 {published data only}
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