Effectiveness of Three Community Based Strategies to Promote Screening for Cervical Cancer

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Abstract
Evaluation of three potential methods for increasing Pap smear use: television media, television media combined with letter based recruitment, and television media combined with general practitioner based (GP based) recruitment. A trial of each intervention was carried out in three postal regions in New South Wales, Australia — a rural locality (containing about 1000 women), a country town (about 3000 women), and a major rural centre (about 10000 women). Three control regions were selected to be demographically similar to the corresponding intervention regions. Outcome data on regional Pap smear rates were obtained from government health insurance claims for cervical screening, and from pathology service records. Expected Pap smear rates for the three months after the intervention were predicted from 45 pre-intervention months and were compared with observed rates for this period. Television media alone was associated with a significant increase in attendances for screening in one of the three regions where a trial was carried out: 13.3% in the rural centre. The media/ letter based campaign was associated with a significant increase in attendances in two out of three regions: 52.7% in the rural locality, 43.2% in the rural centre. The media/GP based campaign was associated with significant increases in attendances in all three regions: 50.2% in the rural locality, 80.8% in the country town, 15.7% in the rural centre. All three interventions were associated with significant increases in the number of women attending for cervical screening above those observed in the control regions. Furthermore, these increases were not restricted to women at low risk. They were also found for older women (aged 50–69 years) and women who had not had a Pap smear within the past three years.