A 3-step intervention to improve adherence to cervical cancer screening: The SCAN randomized controlled trial

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作   者：

Firmino-Machado, Joao;  Varela, Sofia;  Mendes, Romeu;  Moreira, Amelia;  Lunet, Nuno;  Carmo, Alexandra;  Cancela, Ana;  Firmino, Ana;  Ramos, Ana;  Teixeira, Antonieta;  Vieira, Armando;  Badim, Barbara;  Tojal, Carolina;  Junqueira, Claudia;  Pinheiro, Conceicao;  Peneda, Emilia;  Monte, Helena;  Vieira, Hugo Marcelo;  Proenca, Ines;  Seabra, Joana;  Teixeira, Joana;  Magalhaes, Joao;  Batista, Joaquim;  Silva, Justina;  Grijo, Leonor;  Beirao, Liliana;  Castanheira, Manuela;  Silva, Margarida;  Peixoto, Maria Joao;  Santos, Marina Ponto;  Neves, Mariana;  Amaral, Miguel;  Capela, Nuno;  Santos, Paulo;  Apolinario, Pedro;  Aguiar, Rita;  Barbosa, Rita;  Amendoeira, Rui;  Medon, Rui;  Torres, Sofia Pinheiro;  Silva, Susana;  Fernandes, Tiago;  Santos, Vitor; 

作者机构：

Univ Porto;  Porto;  Unidade Saude Publ;  ACeS Porto Ocidental;  EPIUnit Inst Saude Publ;  Portugal; 

关键词：

Text messaging;  Uterine cervical neoplasms;  Early detection of cancer;  Mass screening;  Reminder systems; 

期刊名称：

Preventive Medicine: An International Journal Devoted to Practice and Theory

i s s n：

0091-7435

年卷期：

2019 年 123 卷

页   码：

250-261

页   码：

摘   要：

The aim of this study was to test the effectiveness of a stepwise intervention with an increasing level of complexity and cost to increase adherence to organized cervical cancer screening. This was a randomized (1: 1) controlled trial, conducted among 13 Portuguese primary health care units. Participants (n = 1220) were women aged 25-49 years, eligible for cervical cancer screening, with a mobile phone number available. The tested intervention was a 3-step invitation to screening, based on automated text messages/phone calls (step 1), manual phone calls (step 2) and face-to-face interviews (step 3), applied sequentially to non-adherent women after each step. Participants in the control group were invited through a written letter (standard of care). The primary outcome was the proportion of women screened, which was assessed after step 1 (45 days after the initial invitation), steps 1 + 2 (90 days after the initial invitation) and steps 1 + 2 + 3 (150 days after the initial invitation). Adherence to cervical cancer screening was significantly higher among women assigned to the intervention than those in the control group for step 1 (39.9% vs. 25.7%, p < 0.001), steps 1 + 2 (48.6% vs. 30.7%, p < 0.001) and steps 1 + 2 + 3 (51.2% vs. 34.0%, p < 0.001). In conclusion, adherence to cervical cancer screening was higher by 17% among women invited through the 3-step intervention, compared to those receiving the standard invitation letter. The former strategy has the potential to be broadly implemented due to the low requirements of technology and training.