Effect of cervical cancer education and provider recommendation for screening on screening rates: A systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Although cervical cancer is largely preventable through screening, detection and treatment of precancerous abnormalities, it remains one of the top causes of cancer-related morbidity and mortality globally. OBJECTIVES: The objective of this systematic review is to understand the evidence of the effect of cervical cancer education compared to control conditions on cervical cancer screening rates in eligible women population at risk of cervical cancer. We also sought to understand the effect of provider recommendations for screening to eligible women on cervical cancer screening (CCS) rates compared to control conditions in eligible women population at risk of cervical cancer. METHODS: We used the PICO (Problem or Population, Interventions, Comparison and Outcome) framework as described in the Cochrane Collaboration Handbook to develop our search strategy. The details of our search strategy has been described in our systematic review protocol published in the International Prospective Register of systematic reviews (PROSPERO). The protocol registration number is CRD42016045605 available at: http://www.crd.york.ac.uk/prospero/display_record.asp?src=trip&ID=CRD42016045605. The search string was used in Pubmed, Embase, Cochrane Systematic Reviews and Cochrane CENTRAL register of controlled trials to retrieve study reports that were screened for inclusion in this review. Our data synthesis and reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). We did a qualitative synthesis of evidence and, where appropriate, individual study effects were pooled in meta-analyses using RevMan 5.3 Review Manager. The Higgins I2 was used to assess for heterogeneity in studies pooled together for overall summary effects. We did assessment of risk of bias of individual studies included and assessed risk of publication bias across studies pooled together in meta-analysis by Funnel plot. RESULTS: Out of 3072 study reports screened, 28 articles were found to be eligible for inclusion in qualitative synthesis (5 of which were included in meta-analysis of educational interventions and 8 combined in meta-analysis of HPV self-sampling interventions), while 45 were excluded for various reasons. The use of theory-based educational interventions significantly increased CCS rates by more than double (OR, 2.46, 95% CI: 1.88, 3.21). Additionally, offering women the option of self-sampling for Human Papillomavirus (HPV) testing increased CCS rates by nearly 2-fold (OR = 1.71, 95% CI: 1.32, 2.22). We also found that invitation letters alone (or with a follow up phone contact), making an appointment, and sending reminders to patients who are due or overdue for screening had a significant effect on improving participation and CCS rates in populations at risk. CONCLUSION: Our findings supports the implementation of theory-based cervical cancer educational interventions to increase women's participation in cervical cancer screening programs, particularly when targeting communities with low literacy levels. Additionally, cervical cancer screening programs should consider the option of offering women the opportunity for self-sample collection particularly when such women have not responded to previous screening invitation or reminder letters for Pap smear collection as a method of screening.
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Compared to reminder letters, phone calls to non-responders after the initial letter increased screening.
“Compared to reminder letters, phone calls to non-responders after the initial letter increased screening [51].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [51]
The Results section reports that, among women who did not respond to an initial screening invitation, telephone reminders did not significantly increase screening uptake compared with mailed reminder letters (6.5% vs 5.8%). Other positive findings in the review used different comparators, such as no phone reminder or usual care. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredPromotora-led education programmes increased the knowledge and intention to be screened for CC and BC.
“Promotora-led education programmes also increased the knowledge and intention to be screened for CC [51] and BC [45].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [51]
The Discussion’s “Cervical cancer education” section says educational interventions increased women’s knowledge of cervical cancer. Table 1 in the Results identifies a promotora-administered intervention and reports increased Pap-smear screening, but our copy does not report increased intention to be screened. The breast-cancer portion is attached to a different citation and is not assessed here. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAddressing structural and motivational barriers may be essential to raising participation rates as knowledge does not always translate into action.
“Addressing structural and motivational barriers may be essential to raising participation rates as knowledge does not always translate into action [9, 44, 51, 65].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [51]
In a meta-analysis, theory-based, culturally and linguistically sensitive, community participatory educational interventions demonstrated a consistent positive effect on CC screening.
“In a meta-analysis, theory-based, culturally and linguistically sensitive, community participatory educational interventions demonstrated a consistent positive effect on CC screening [51].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [51]
Invitations in different forms (e.g., letters, text messages, phone calls) have increased cancer screening.
“Invitations in different forms have increased cancer screening (e.g., letters, text messages, phone calls) [42,51,52].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [51]
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- Authors
- Musa, J., Achenbach, C. J., O’Dwyer, L. C., Evans, C. T., McHugh, M., Hou, L., Simon, M. A., Murphy, R. L., & Jordan, N.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Musa, Jonah
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-09-05
- Volume
- 12
- Issue
- 9
- Pages
- e0183924
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5584806
- OpenAlex
- W2753548446
- Cited by
- 223
- References
- 103
- Citations by year
- 2026: 23 · 2025: 23 · 2024: 29 · 2023: 22 · 2022: 41 · 2021: 40 · 2020: 25 · 2019: 13 · 2018: 6 · 2017: 1
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Update notices
- correction (2017-12-29)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- Fogarty International Center (US) (D43TW009575)
- National Cancer Institute (1 U54 CA221205-01)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- cervical cancer screening, provider recommendation, screening rates, educational intervention, HPV self-sampling, HPV testing, theory-based intervention, women's health promotion, screening uptake, cervical cancer prevention, risk communication, health behavior change
- MeSH terms
- Uterine Cervical Neoplasms, Female, Health Education, Humans, Mass Screening, Patient Education as Topic, Prospective Studies, Quality of Life, Bias, Treatment Outcome, Papillomaviridae, Early Detection of Cancer
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