Client-Directed Interventions to Increase Community Demand for Breast, Cervical, and Colorectal Cancer Screening

Baron, Roy C.; Rimer, Barbara K.; Breslow, Rosalind A.; Coates, Ralph J.; Kerner, Jon; Melillo, Stephanie; Habarta, Nancy; Kalra, Geetika P.; Chattopadhyay, Sajal K.; Wilson, Katherine; Lee, Nancy C.; Mullen, Patricia Dolan; Coughlin, Steven S.; Briss, Peter A.

doi:10.1016/j.amepre.2008.04.002

Cited by 215 publications

(206 citation statements)

References 120 publications

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“…This strategy appears to be particularly effective in improving cancer screening rates in large municipalities. In most Western countries, the importance of a national call-recall system, which gives call and recall notifications by mail or telephone, is well recognized by the government for the purposes of increasing cancer screening (Quinn et al, 1998;Baron et al, 2008b). In Japan, municipalities are responsible for implementing strategies to improve cancer screening rates.…”

Section: Discussionmentioning

confidence: 99%

What is the Most Effective Strategy for Improving the Cancer Screening Rate in Japan?

Sano¹,

Goto²,

Hamashima³

2014

Asian Pacific Journal of Cancer Prevention

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Background: Cancer screening rates in Japan are much lower than those in Western countries. This study evaluated the relationship between cancer screening rates and strategies used to improve screening rates, and determined which strategy is the most effective. Materials and Methods: All municipalities are responsible for conducting gastric, lung, colorectal, cervical, and breast cancer screenings in Japan. Of the 1,746 municipalities in total, 92-99% were included in the analyses for each cancer screening. Using national data in 2009, the correlations between cancer screening rates and strategies for improving screening rates of all municipalities, both large (populations of over 30,000) and small (populations of under 30,000), were determined. The strategies used were as follows: sending personal invitation letters, personal visits by community health workers, use of a clinical setting for screening, and free screening. Results: Of all four strategies used to improve cancer screening rates, sending personal invitation letters had the highest correlations with all screening rates, with the exception of breast cancer screening. The partial correlation coefficients linking this strategy with the screening rates in all municipalities were 0.28, 0.32, 0.30, and 0.26 for gastric, lung, colorectal, and cervical cancer screening, respectively. In large municipalities, the correlations between the number of examinees in a clinical setting and the screening rates were also relatively high, particularly for cervical cancer screening (r=0.41). Conclusions: Sending personal invitation letters appears to be particularly effective in improving cancer screening rates in all municipalities. All municipalities should implement a system that sends personal invitation letters for cancer screening. In large municipalities, increasing the availability of screening in a clinical setting is also effective in improving cancer screening rates.

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Section: Discussionmentioning

confidence: 99%

What is the Most Effective Strategy for Improving the Cancer Screening Rate in Japan?

Sano¹,

Goto²,

Hamashima³

2014

Asian Pacific Journal of Cancer Prevention

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“…Interventions at the individual level, which have shown to modify and improve negative perceptions and attitudes to screening in harder-to-reach individuals include the use of psycho-educational material as an alternative to regular screening invitations (Wardle et al, 2003) as well as enhanced reminders. Since some evidence also exists on the effectiveness of small media and group educational interventions in increasing uptake of CRC screening future studies should aim to integrate different approaches to investigate the extent of their effect in reducing the social gradient in uptake (Baron et al, 2008).…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Solmi

Wagner

Kobayashi

et al. 2015

Social Science & Medicine

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Colorectal cancer (CRC) is the second largest cause of cancer death in the UK. Since 2010, CRC screening based on Faecal Occult Blood testing has been offered by the NHS in England biennially to all persons age 60 to 69 years. Several studies have demonstrated a gradient in uptake using area-level markers of socio-economic status (SES), but few have examined the individual-level contributors to the gradient. We aimed to quantify the extent of SES inequality in CRC screening uptake in England using individual-level data, and to identify individual factors associated with this inequality.We used data from 1,833 participants (aged 61-69) in Wave 5 (collected in years 2010/11) of the English Longitudinal Study of Ageing (ELSA) eligible for having been sent at least one CRC screening invitation. Uptake was defined by self-report of ever having been screened as part of the National Screening Programme. We assessed socio-economic inequality using the corrected concentration index of uptake against SES rank, which was derived by regressing a range of SES markers against net non-pension household wealth. Other demographic and health-related variables were included in the analysis. Factors associated with inequality were measured using concentration index decomposition.There was a significant pro-rich gradient in screening uptake (concentration index: 0.16, 95% CI:0.11-0.22), mostly explained within our model by differences in non-pension wealth (38.7%), partner screening status (15.9%), sickness/disability (13.5%), and health literacy (8.5%).Interventions aimed at reducing inequalities in CRC screening uptake should focus on improving acceptability of screening in populations with low levels of education and literacy barriers.

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“…For example, there was strong evidence that reminders significantly increase uptake of cancer screening. 203,225 However, workstream 1 focus group participants consistently reported not recognising the letter. The text at the top of the letter was therefore designed to clearly state the purpose and may have increased its personal relevance ('A reminder to you').…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Raine

Atkin

Wagner

et al. 2017

Programme Grants Appl Res

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Objective: To reduce socioeconomic inequalities in uptake of the NHS BCSP ’ s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group. Design: Workstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘ gist ’ information, (2) a ‘ narrative ’ leaflet, (3) ‘ general practice endorsement ’ (GPE) and (4) an ‘ enhanced reminder ’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention. Methods: Interventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘ usual care ’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘ gist ’ leaflet ( n = 163,525), (2) ‘ narrative ’ leaflet ( n = 150,417), (3) GPE on the invitation letter ( n = 265,434) and (4) ER ( n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual ’ s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘ definitive ’ test result of either ‘ normal ’ (i.e. no further investigation required) or ‘ abnormal ’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome. Results: The gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; all p -values > 0.05). GPE showed no effect on the gradient ( p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10; p < 0.0001]. ER showed a significant interaction with SECs ( p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20; p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06; p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11; p = 0.001). All interventions were inexpensive to provide. Limitations: In line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect. Conclusions: Enhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results hig...

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Client-Directed Interventions to Increase Community Demand for Breast, Cervical, and Colorectal Cancer Screening

Cited by 215 publications

References 120 publications

What is the Most Effective Strategy for Improving the Cancer Screening Rate in Japan?

What is the Most Effective Strategy for Improving the Cancer Screening Rate in Japan?

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

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