title: Improving uptake of cervical cancer screening in women with prolonged history of non-attendance for screening: a randomized trial of enhanced invitation methods.
abstract: OBJECTIVE
  To compare the effectiveness and cost-effectiveness of three methods of inviting women with a long history of non-attendance to undergo cervical screening.
  
  
  METHODS
  Randomized controlled trial and cost-effectiveness analysis. In all, 1140 women were identified from routine NHS screening records as having no smear for at least 15 years and randomly allocated to receive a telephone call from a nurse, a letter from a well-known celebrity (Claire Rayner) or letter from the local NHS Cervical Screening Commissioner. Uptake of screening was measured using routine data and attributed to interventions if occurring within three months. Uptake was compared with a control group. Costs of carrying out the interventions were noted from the perspective of the NHS and cost-effectiveness, as cost per additional attender, calculated.
  
  
  RESULTS
  Uptake following all interventions was low: telephone call (1.4, 95% confidence interval [CI] 0.38-3.6%); celebrity letter (1.8, 95% CI 0.57-4.0%); commissioner letter (4.6, 95% CI 2.5-7.7%); control group (1.8, 95% CI 0.57-4.0%). There were no significant differences between groups. Telephone intervention was not possible in a quarter of women whose numbers were unlisted. Telephone intervention was the most expensive and least effective of the interventions. The commissioner letter yielded an additional attender within three months at an incremental cost of 23.21 pounds compared with taking no action.
  
  
  CONCLUSIONS
  Neither a telephone call from a nurse nor a letter from a celebrity to encourage attendance for cervical screening were effective or cost-effective in women with a prolonged history of non-participation in the screening programme. A letter from the local cervical screening programme commissioner resulted in a small, non-significant increase in uptake. The low cost and ease of implementation of this intervention supports further research into its use in routine practice.
authors.affiliation: Peninsula Technology Assessment Group, Peninsula Medical School, University of Exeter, Noy Scott House, Barrack Road, Exeter EX2 5DW, UK. ken.stein@exeter.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Stein
authors.forename: G
authors.initials: G
authors.lastname: Lewendon
authors.forename: R
authors.initials: R
authors.lastname: Jenkins
authors.forename: C
authors.initials: C
authors.lastname: Davis
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010565:Persuasive Communication; D017010:Reminder Systems / Q000145:classification / Q000191:economics*; D013222:State Medicine / Q000191:economics; D013997:Time Factors; D016312:Treatment Refusal; D006113:United Kingdom; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data*