Mass media campaigns may increase cervical cancer screening when combined with more personalised strategies

Hou, Su-I Dr PH, RN, CHES

Department of Health Promotion and Behavior; School of Health and Human Performance; College of Education, University of Georgia, USA

Abstracted from:Black M, Yamada J, Mann V. A systematic literature review of the effectiveness of community-based strategies to increase cervical cancer screening. Can J Public Health 2002; 93: 386-393 .

Source of funding: Ontario Ministry of Health and LongTerm Care; Hamilton Social and Public Health Services.

Correspondence to: M Black, School of Nursing, McMaster University, Ontario, Canada. Email: [email protected]

Abstract prepared by Bazian Ltd, London

Evidence-based Healthcare 7(1):p 1-2, March 2003.

BACKGROUND

Cervical cancer is one of the most common malignancies among women aged 20 to 49 years. Papanicolaou (pap) screening may reduce cervical cancer incidence and mortality. About one quarter of women aged 18 to 69 do not have regular pap tests.

OBJECTIVE

To evaluate the effectiveness of interventions to increase cervical screening among women in community-based settings.

METHOD

Systematic review.

SEARCH STRATEGY

Two librarians searched MEDLINE, Current Contents, CINAHL, Health-STAR, EMBASE, PsychInfo, Sociological Abstracts, Dissertation Abstracts and the Cochrane Library (1989 to September 1999). Nine core journals were hand searched (1994 to 1999). Experts were contacted for unpublished literature. Unpublished French language studies were retrieved through web searches and a manual search of DOCUMENSA (1990 to 1999).

INCLUSION/EXCLUSION CRITERIA

English or French language studies of community interventions to increase the uptake of pap tests were eligible. Of 428 papers retrieved, 50 articles describing 42 different studies were relevant. Four pairs of reviewers assessed relevance and two reviewers assessed sample selection, study design, control for confounders, blinding, data collection and follow-up. Nineteen studies of 'high' or 'moderate' quality were included. Six of these were controlled trials, six were cohort studies, four were single-group pre-post test studies and three were interrupted time series. Interventions included mass media campaigns, educational videos, individual counselling, free screening, mailed reminders and peer educators.

DATA EXTRACTION

Two reviewers collated findings independently using a customised data extraction tool. Primary outcomes were identified and clinical and statistical significance noted. The authors provide a narrative synthesis.

MAIN OUTCOMES

Pap smear rates.

MAIN RESULTS

Twelve out of 17 studies that measured pap smear rates found a significant improvement using community-based interventions, although net gains were sometimes small. Increases in screening uptake ranged from 61% for an educational video to 12% for a letter from a physician. One out of four studies found media campaigns alone to be effective. All five interventions that combined media campaigns with other techniques increased pap smear rates or early cancer detection. Letters of invitation increased uptake, but required a centralised registry or survey to identify eligible women.

AUTHORS' CONCLUSIONS

Successful interventions to increase cervical screening combine mass media campaigns with direct tailored information to women, healthcare providers, or both. Letters of invitation may be beneficial, but require a centralised registry.