Wilding Sarah, Wighton Sarah, West Robert, Conner Mark, O'Connor Daryl B
School of Psychology, University of Leeds, Leeds, UK.
NHS England and NHS Improvement (North East & Yorkshire), UK.
Soc Sci Med. 2023 Apr;322:115800. doi: 10.1016/j.socscimed.2023.115800. Epub 2023 Feb 22.
Cervical cancer is the fourth most common cancer to occur in women worldwide. In the UK, the NHS cervical screening programme invites eligible individuals to take part in screening every 3-5 years. At present, around 70% of individuals attend screening when invited. The present study aimed to test the effectiveness of a volitional and a motivational intervention alone and in combination on screening uptake at 16-week follow up.
14,536 participants were recruited from the list of eligible participants invited for screening in Yorkshire, Humber and the North East regions of England in December 2021. They were randomised to a social norm-based motivational intervention (SNA); implementation intention-based Volitional Help Sheet (VHS); combined intervention (SNA + VHS); or treatment as usual control. The primary outcome was screening uptake measured via patient screening records at 16 weeks.
Of the 14,466 participants with eligible data for analysis, 5793 (40.0%) attended for cervical cancer screening in the 16 weeks after the intervention mailing. Both age and deprivation influenced screening uptake, with lower uptake in the youngest individuals and those from more deprived areas. Compared to control, there was no evidence of any benefit from the VHS implementation intervention alone (Adj.OR = 0.99, 95% CI 0.90 to 1.10), the SNA motivational intervention alone (Adj.OR = 0.89; 95% CI: 0.80 to 0.99), or the combined intervention (Adj.OR = 0.96, 95% CI 0.86 to 1.06).
The study did not support any benefit of either VHS or SNA interventions alone or in combination on cervical cancer screening uptake. It did demonstrate alarmingly low levels of screening uptake at 16 weeks which were well below the average rate. Future research needs to urgently investigate and understand the barriers to uptake following on from the COVID-19 pandemic.
宫颈癌是全球女性中第四大常见癌症。在英国，国民保健服务（NHS）宫颈癌筛查计划邀请符合条件的个体每3至5年参加一次筛查。目前，约70%的个体在收到邀请时会参加筛查。本研究旨在测试单独及联合使用意志干预和动机干预对16周随访时筛查参与率的有效性。
2021年12月，从英格兰约克郡、亨伯和东北地区被邀请参加筛查的符合条件参与者名单中招募了14536名参与者。他们被随机分为基于社会规范的动机干预（SNA）组、基于实施意图的意志帮助表（VHS）组、联合干预（SNA + VHS）组或常规治疗对照组。主要结局是通过16周时的患者筛查记录测量的筛查参与率。
在14466名有合格数据可供分析的参与者中，5793人（40.0%）在干预邮件发送后的16周内参加了宫颈癌筛查。年龄和贫困程度均影响筛查参与率，最年轻的个体以及来自更贫困地区的个体参与率较低。与对照组相比，没有证据表明单独的VHS实施干预（调整后比值比[Adj.OR]=0.99，95%置信区间[CI]为0.90至1.10）、单独的SNA动机干预（Adj.OR = 0.89；95% CI：0.80至0.99）或联合干预（Adj.OR = 0.96，95% CI 0.86至1.06）有任何益处。
该研究不支持单独或联合使用VHS或SNA干预对宫颈癌筛查参与率有任何益处。研究确实表明16周时的筛查参与率低得惊人，远低于平均水平。未来的研究需要紧急调查和了解新冠疫情之后筛查参与的障碍。
