A 3-step intervention to improve adherence to cervical cancer screening: The SCAN randomized controlled trial
Abstract
The aim of this study was to test the effectiveness of a stepwise intervention with an increasing level of complexity and cost to increase adherence to organized cervical cancer screening. This was a randomized (1: 1) controlled trial, conducted among 13 Portuguese primary health care units. Participants (n = 1220) were women aged 25-49 years, eligible for cervical cancer screening, with a mobile phone number available. The tested intervention was a 3-step invitation to screening, based on automated text messages/phone calls (step 1), manual phone calls (step 2) and face-to-face interviews (step 3), applied sequentially to non-adherent women after each step. Participants in the control group were invited through a written letter (standard of care). The primary outcome was the proportion of women screened, which was assessed after step 1 (45 days after the initial invitation), steps 1 + 2 (90 days after the initial invitation) and steps 1 + 2 + 3 (150 days after the initial invitation). Adherence to cervical cancer screening was significantly higher among women assigned to the intervention than those in the control group for step 1 (39.9% vs. 25.7%, p < 0.001), steps 1 + 2 (48.6% vs. 30.7%, p < 0.001) and steps 1 + 2 + 3 (51.2% vs. 34.0%, p < 0.001). In conclusion, adherence to cervical cancer screening was higher by 17% among women invited through the 3-step intervention, compared to those receiving the standard invitation letter. The former strategy has the potential to be b…
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Both invitations and reminder systems have the potential to be broadly implemented due to low requirements of technology and training.
“Both invitations and reminder systems have the potential to be broadly implemented due to the low requirements of technology and training [55].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [55]
Invitations and reminders with increasing intensity and modes of contact for non-response have been effective in Portugal (51%) compared to letter only (34%).
“Invitations and reminders with increasing intensity and modes of contact for non-response have been effective in Portugal (51%) compared to letter only (34%) [55].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [55]
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References 17 · Cited by 20
- Authors
- Firmino-Machado, J., Varela, S., Mendes, R., Moreira, A., Lunet, N., Carmo, A., Cancela, A., Firmino, A., Ramos, A., Teixeira, A., Vieira, A., Badim, B., Tojal, C., Junqueira, C., Pinheiro, C., Peneda, E., Monte, H., Vieira, H. M., Proença, I., Seabra, J., Teixeira, J., Magalhães, J., Batista, J., Silva, J., Grijó, L., Beirão, L., Castanheira, M., Silva, M., Peixoto, M. J., Ponto Santos, M., Neves, M., Amaral, M., Capela, N., Santos, P., Apolinário, P., Aguiar, R., Barbosa, R., Amendoeira, R., Medon, R., Pinheiro Torres, S., Varela, S., Silva, S., Fernandes, T., & Santos, V.
- Affiliations
- Universidade do Porto (PT)
- ORCID
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 123
- Pages
- 250-261
- ISSN
- 0091-7435 (ISSN-L)
- OpenAlex
- W2928617529
- Cited by
- 20
- References
- 17
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 5 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 2
- FWCI
- 1.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion)
- Funders
- Instituto De Saúde Pública, Universidade do Porto
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- cervical cancer screening, screening adherence, screening invitations, telephone calls, face-to-face interviews, primary care
- MeSH terms
- Adult, Age Factors, Uterine Cervical Neoplasms, Female, Humans, Middle Aged, Patient Acceptance of Health Care, Patient Compliance, Portugal, Vaginal Smears, Logistic Models, Reminder Systems, Outcome Assessment, Health Care, Risk Assessment, Guideline Adherence, Early Detection of Cancer, Text Messaging
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