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Background: Cervical cancer is almost entirely preventable through vaccination and screening, yet remains one of the 'gravest threats to women's lives' according to the World Health Organization. Specific high-risk subtypes of human papillomavirus (HR-HPV) are well-established as the primary cause of cervical cancer. Uganda has one of the highest cervical cancer incidence rates in the world (54.8 per 100,000) as a result of limited screening access and infrastructure. The integration of a self-collected cervical cancer screening program using HPV testing within existing community-based primary health care services could increase access to screening and reduce cervical cancer rates among Ugandan women. Methods: Using a pragmatic, sequential, cluster randomized trial design; we will compare the effectiveness of two cervical cancer screening models for self-collected HPV testing: 1) community health worker recruitment (door-todoor); and 2) community health meetings. In Mayuge district, Uganda, 31 villages are randomized to one of two treatment arms. Due to the nature of this trial, blinding is not possible. Women are eligible to participate if they have no previous history of hysterectomy or treatment for cervical cancer or pre-cancer and are aged 25-49 years old. All participants receive an integrated package of cervical cancer screening and education. Samples are tested for HPV using GeneXpert point of care testing. All women who test positive for HR-HPV types are referred to a designated health centre for follow-up inspection by Visual Inspection with Acetic acid (VIA) and treatment with thermal ablation. The primary outcome for the trial is the number of women who attend follow-up for VIA screening at a designated Health Centre after a positive HR-HPV test out of all women screened per arm. Secondary outcomes include: cervical cancer screening knowledge; patient-reported experience measures for self-collected cervical cancer screening; and HPV incidence. Discussion: Results from this study will inform the national scale-up of cervical cancer screening in Uganda, aligning with the World Health Organization's target of achieving cervical cancer elimination through the pillar of increased HPV screening coverage.

Background Social media are an increasingly commonly used platform for delivering health promotion interventions. Although recent research has focused on the effectiveness of social media interventions for health promotion, very little is known about the optimal content within such interventions, and the active ingredients to promote health behavior change using social media are not clear. Identifying which behavior change techniques (BCTs) are reported may help to clarify the content of interventions using a generalizable terminology that may facilitate future intervention development. Objective This study aimed to identify which BCTs are reported in social media interventions for promoting health behavior change in adults. Methods We included 71 studies conducted with adult participants (aged ≥18 years) and for which social media intervention was considered interactive in a Cochrane review of the effectiveness of such interventions. We developed a coding manual informed by the Behavior Change Technique Taxonomy version 1 (BCTTv1) to identify BCTs in the included studies. We identified BCTs in all study arms (including control) and described BCTs in the group and self-directed components of studies. We characterized the dose of delivery for each BCT by low and high intensity. We used descriptive analyses to characterize the reported BCTs. Results Our data consisted of 71 studies published from 2001 to 2017, mainly conducted in high-income countries (n=65). Most studies (n=31) used tailored, interactive websites to deliver the intervention; Facebook was the most used mainstream platform. In developing our coding manual, we adapted some BCTTv1 instructions to better capture unique nuances of how BCTs were operationalized in social media with respect to likes, retweets, smiles, congratulations, and badges. Social support (unspecified), instruction on how to perform the behavior, and credible source were most frequently identified BCTs in intervention arms of studies and group-delivery settings, whereas instruction on how to perform the behavior was most commonly applied in self-directed components of studies, control arms, and individual participant settings. Instruction on how to perform the behavior was also the most frequently reported BCT in both intervention and control arms simultaneously. Instruction on how to perform the behavior, social support (unspecified), self-monitoring of behavior, information about health consequences, and credible source were identified in the top 5 BCTs delivered with the highest intensity. Conclusions This study within a review provides a detailed description of the BCTs and their dose to promote behavior change in web-based, interactive social media interventions. Clarifying active ingredients in social media interventions and the intensity of their delivery may help to develop future interventions that can more clearly build upon the existing evidence.

BackgroundThe importance of sex and gender considerations in research is being increasingly recognized. Evidence indicates that sex and gender can influence intervention effectiveness. We assessed the extent to which sex/gender is reported and analyzed in Campbell and Cochrane systematic reviews.MethodsWe screened all the systematic reviews in the Campbell Library (n = 137) and a sample of systematic reviews from 2016 to 2017 in the Cochrane Library (n = 674). We documented the frequency of sex/gender terms used in each section of the reviews.ResultsWe excluded 5 Cochrane reviews because they were withdrawn or published and updated within the same time period as well as 4 Campbell reviews and 114 Cochrane reviews which only included studies focused on a single sex. Our analysis includes 133 Campbell reviews and 555 Cochrane reviews. We assessed reporting of sex/gender considerations for each section of the systematic review (Abstract, Background, Methods, Results, Discussion). In the methods section, 83% of Cochrane reviews (95% CI 80–86%) and 51% of Campbell reviews (95% CI 42–59%) reported on sex/gender. In the results section, less than 30% of reviews reported on sex/gender. Of these, 37% (95% CI 29–45%) of Campbell and 75% (95% CI 68–82%) of Cochrane reviews provided a descriptive report of sex/gender and 63% (95% CI 55–71%) of Campbell reviews and 25% (95% CI 18–32%) of Cochrane reviews reported analytic approaches for exploring sex/gender, such as subgroup analyses, exploring heterogeneity, or presenting disaggregated data by sex/gender.ConclusionOur study indicates that sex/gender reporting in Campbell and Cochrane reviews is inadequate.

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2010, Issue 12 http://www.thecochranelibrary.com How effects on health equity are assessed in systematic reviews of interventions (Review)