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.
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.
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.
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.
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.
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
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.
This trial was prospectively registered on the ISRCTN register:
Strategies to increase cervical screening uptake at first invitation