title: Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial.
abstract: BACKGROUND
  Opportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage.
  
  
  METHODS
  The CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona.A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a "rescue" visit as the screening visit resulting from the study invitation.
  
  
  RESULTS
  Among the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p<0.001). However, the differences were more substantial in the age groups 50-59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women.
  
  
  CONCLUSIONS
  The study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01373723.
authors.affiliation: Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Català de la Salut, Ripollet, Spain.|Unitat de Suport a la Recerca Metropolitana Nord. Institut de Investigació en Atenció Primària (IDIAP) Jordi Gol. Sabadell, Spain.|Departament de Medicina, Universitat de Barcelona. Barcelona, Spain.|Grup de Recerca en Atenció Sexual i Reproductiva IDIAP Jordi Gol. Sabadell, Spain.
authors.forename: Amelia
authors.initials: A
authors.lastname: Acera
authors.affiliation: Unitat de Suport a la Recerca Metropolitana Nord. Institut de Investigació en Atenció Primària (IDIAP) Jordi Gol. Sabadell, Spain.|Departament de Infermeria. Universitat Autònoma de Barcelona. Bellaterra, Cerdanyola, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Manresa
authors.affiliation: Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Català de la Salut, Ripollet, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Rodriguez
authors.affiliation: Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Català de la Salut, Ripollet, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodriguez
authors.affiliation: Servei d'Atenció Primària SAP Vallés Occidental. Institut Català de la Salut, Sabadell, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Bonet
authors.affiliation: Center for Research in Economics and Health (CRES). University Pompeu Fabra, Barcelona, Spain.|Universidad de Castilla La Mancha. Ciudad Real, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Trapero-Bertran
authors.affiliation: Servei d'Atenció Primària SAP Vallés Occidental. Institut Català de la Salut, Sabadell, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Hidalgo
authors.affiliation: Servei d'Atenció Primària SAP Vallés Occidental. Institut Català de la Salut, Sabadell, Spain.
authors.forename: Norman
authors.initials: N
authors.lastname: Sànchez
authors.affiliation: Cancer Epidemiology Research Programme | IDIBELL | Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.|Centro de Investigación Biomédica en Red en Epidemiologia y Salud Pública CIBERESP, Barcelona, Spain.
authors.forename: Silvia
authors.identifier: http://orcid.org/0000-0002-5909-676X
authors.initials: S
authors.lastname: de Sanjosé
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015709:Correspondence as Topic; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010174:Pamphlets; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods; D010565:Persuasive Communication; D013030:Spain; D013689:Telephone; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*