title: Impact of invitation and reminder letters on cervical cancer screening participation rates in an organized screening program.
abstract: Study's Objective was to explore the impact of invitation and reminder letters on cervical cancer screening participation among eligible Ontario women 30 to 69years of age. A cross-sectional study was used to describe factors and screening patterns for 1,150,783 eligible women. A cohort design was used to compare the impact of invitation and reminder letters on Pap uptake comparing women who received the intervention (n=99,278) with a historical non-intervention group (n=130,181). Factors that might influence screening participation were included as covariates in a multivariable logistic regression models. Overall, 26.7% of women who had a Pap test 3 to 5years prior and 9.8% of women with no Pap test in the previous 5years were screened within 9months after the intervention. On cohort analysis, 14.1% of women in the intervention group and 8.5% of women in the non-intervention group were screened within 9months. Being mailed an invitation letter was associated with greater likelihood of screening (OR=1.8, CI 1.7-1.8). Controlling for covariates, the letter intervention was associated with 9month screening for both women with a Pap test 3 to 5years prior (AOR=1.7, CI 1.6-1.8) and those with no Pap test in the previous 5years (AOR=1.8, CI 1.7-1.9). There was a significant effect of all covariates on the participation. The invitation and reminder letter strategy increased cervical cancer screening participation. Additional strategies that could encourage eligible women to participate and/or removing barriers to screening for eligible women may be necessary.
authors.affiliation: Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON M5G 1X3, Canada. Electronic address: Simontavasoli16@gmail.com.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Tavasoli
authors.affiliation: Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON M5G 1X3, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario M5T 3M7, Canada. Electronic address: Anna.kone@cancercare.on.ca.
authors.forename: Anna J Kone
authors.initials: AJ
authors.lastname: Pefoyo
authors.affiliation: Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON M5G 1X3, Canada. Electronic address: Joanne.hader@cancercare.on.ca.
authors.forename: Joanne
authors.initials: J
authors.lastname: Hader
authors.affiliation: Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON M5G 1X3, Canada. Electronic address: Alex.lee@cancercare.on.ca.
authors.forename: Alex
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON M5G 1X3, Canada; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology University of Toronto, Sunnybrook Health Sciences Centre, etc., 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada. Electronic address: Rachel.Kupets@sunnybrook.ca.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kupets
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009864:Ontario; D065006:Papanicolaou Test; D011177:Postal Service; D017010:Reminder Systems / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears
keywords: Cervical cancer screening; Invitation letters; Pap test; Participation rate; Population-based; Reminder letters