Interventions to improve cervical cancer screening uptake amongst young women: A systematic review

Figures & data

Figure 1. PRISMA flow diagram.

Table I. Characteristics of included studies.

Study	N (N aged 25–34)	Population	Study design	Interventions	Comparison	Location
Eaker et al., 2004 [30]	12 240 (2941 aged 24–29 received intervention)	Women aged 25–59	Randomised controlled trial	1. Modified invitation letter 2. Reminder letter after first intervention 3. Phone reminder after reminder letter	1. Standard invitation letter 2. No reminder letter 3. No phone reminder	Uppsala county, Sweden
Morrell et al., 2005 [32]	90 000 (34 397 aged 20–34)	Women aged 20–69	Randomised controlled trial	Reminder letter	No reminder letter	New South Wales, Australia
McDowell et al., 1989 [31]	2034	Women aged 18–35	Randomised controlled trial	1. Physician reminder 2. Letter reminder 3. Phone reminder	1. No physician reminder 2. No letter reminder 3. No phone reminder	Ottawa, Canada
Virtanen et al., 2011 [33]	8699 (1557 aged 30–34)	Women aged 30–60	Randomised controlled trial	HPV self-sampling	Reminder letter	Espoo, Finland

Table II. The effect of invitation letters, reminder letter and HPV self-sampling on cervical screening uptake in young women.

Study	Comparison	Outcome measure	N	Results
Invitation letters
Eaker et al., 2004 [30]	Modified vs. standard invitation letter	Difference in proportion of women attending screening after intervention compared to reference class	2941 received intervention	2.0% less women attended for screening in the intervention group (95% CI 25.0–1.0)
Reminder letters
Eaker et al., 2004 [30]	Reminder letter vs. no reminder letter	Difference in proportion of women attending screening after intervention, compared to reference class	2271 women received intervention	7.9% more women attended (95% CI 5.4–10.4)
Morrell et al., 2005 [32]	Reminder letter vs. no reminder letter	Pap test rate ratio in women receiving letter compared with women not receiving the reminder letter	22 961 women received intervention	Age 20–24: pap test rate ratio 0.98 (95% CI 0.72–1.35); 4.02% vs. 4.09% Age 25–29: pap test rate ratio 1.48 (95% CI 1.20–1.82); 3.83% vs. 2.58% Age 30–34: pap test rate ratio 1.39 (95% CI 1.15–1.68); 3.60% vs. 2.59%
McDowell et al., 1989 [31]	Letter reminder vs. no reminder	Percentage of women screened compared to control group	293 women received intervention	25.9% (76/293) of women were screened compared to 13.7% (35/255) of controls
Eaker et al., 2004 [30]	Phone reminder vs. no phone reminder	Difference in proportion of women attending screening after intervention, compared to reference class	445 women received intervention	21.7% more women attended (95% CI 14.7–28.7)
McDowell et al., 1989 [31]	Phone reminder vs. no reminder	Percentage of women screened compared to control group	300 women received intervention	20.0% (60/300) of women were screened compared to 13.7% (35/255) of controls
McDowell et al., 1989 [31]	Physician reminder vs. no reminder	Percentage of women screened compared to control group	255 women received intervention	16.1% (41/255) of women were screened compared to 13.7% (35/255) of controls
HPV self-sampling
Virtanen et al., 2011 [33]	HPV self-sampling vs. reminder letter	Percentage of women screened compared to the control group	413 women were offered the self-sampling intervention	110/413 women (26.6%) were screened following the offer of HPV-self sampling, 246/1144 women (21.5%) were screened following a reminder letter. Relative risk = 1.23 (95% CI 1.01–1.48)

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