Accessibility statement

Interventions to increase cervical screening uptake at first invitation in young women: a randomised controlled trial (STRATEGIC)

This trial tested new ways to encourage young women to attend their first cervical screen. The overall impact of various interventions was small, though timed appointments and self-sampling kits sent to non-attenders at 6 months are likely to be a cost-effective means of increasing uptake. 

Why did we do this research?

Falling participation by young women in cervical screening has been observed at a time that has seen an increase in the incidence of cervical cancer in the UK in women aged < 35 years. Various barriers to screening have been documented, including fear, embarrassment and inconvenience. We set out to measure the feasibility, clinical and cost-effectiveness of a range of interventions to increase the uptake of cervical screening among young women.

What did we do?

The trial involved two groups of young women: one group aged 24 years in Manchester and the other aged 20 years in Scotland, all of whom had been offered the human papillomavirus vaccination on the national programme. General practices were randomised to different interventions and the trial ran in two phases. Phase 1 involved all women invited for their first cervical screen and tested a specially designed pre-invitation leaflet and online booking. In phase 2, self-sampling kits (SSKs) were sent and offered, and a nurse navigator, timed appointments and a choice between SSKs and nurse navigators were tested. In both phases a number of general practices did not test any new interventions, Phase 1 involved 20,879 women and phase 2 involved 10,126 women. The effectiveness of the new methods was demonstrated by comparing screening uptake with that in the control practices.

What did we find?

Neither the pre-invitation leaflet nor online booking had any impact on uptake of cervical screening coverage after 3 and 6 months. In phase 2, both SSK sent and timed appointments interventions did achieve a small but significant increase in the uptake of screening, and these methods are likely to be cost-effective.

What have we learned? 

Future work should focus on optimising self-sampling in terms of age range, timing of offer for non-attenders and use of urine testing instead of vaginal samples.

Outputs

Kitchener HC, Gittins M, Rivero-Arias O, Tsiachristas A, Cruickshank M, Gray A, et al. A cluster randomised trial of strategies to increase cervical screening uptake at first invitation (STRATEGIC). Health Technol Assess 2016;20(68) https://doi.org/10.3310/hta20680

Privacy Notice: How we use your research data

Funding

The research was commissioned by NIHR HTA programme (Award ID: 09/164/01) and a grant of £1,153,903.03 awarded. The project was started in November 2011 and completed in October 2015.

 

 

Study registration

This trial was prospectively registered on the ISRCTN register:

ISRCTN52303479 https://doi.org/10.1186/ISRCTN52303479

Strategies to increase cervical screening uptake at first invitation

Team

  • David Torgerson - Department of Health Sciences, University of York, York, UK
  • Henry C Kitchener (Chief Investigator) - Institute of Cancer Sciences, University of Manchester, St Mary’s Hospital, Manchester, UK
  • Loretta Brabin - Institute of Cancer Sciences, University of Manchester, St Mary’s Hospital, Manchester, UK
  • Emma J Crosbie - Institute of Cancer Sciences, University of Manchester, St Mary’s Hospital, Manchester, UK
  • Matthew Gittins - Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
  • Chris Roberts - Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
  • Oliver Rivero-Arias - National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  • Apostolos Tsiachristas - Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  • Alastair Gray - Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  • Margaret Cruickshank - Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK
  • Alexandra Sargent - Virology Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK