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A cluster randomised trial of strategies to increase cervical screening uptake at first invitation

Compiled by Vari Drennan, professor of health care and policy research, St Geroge’s University of London and Kingston University, London.

A cluster randomised trial of strategies to increase cervical screening uptake at first invitation

There has been an increase in the incidence of cervical cancer in women under 35, and a decrease in young women taking up cervical screening invitations.

Cervical cancer
Cervical cancer screening. Picture: iStock

While barriers such as embarrassment have been well documented, this cluster-randomised trial, based on general practices in Greater Manchester and the Grampian region, investigated the feasibility, clinical effectiveness and cost-effectiveness of a range of interventions to increase uptake in this age group.

In the first phase, of 20,879 women receiving their first invitation, half were randomised by practice to receive a pre-invitation leaflet. Those in Manchester had access to online appointment booking.

In the second phase, the 10,126 women who had not attended by six months were randomised by practice to receive one of:

  • a vaginal self-sampling kit (SSK)
  • the offer of SSK on request
  • an appointment
  • access to a nurse navigator (NN)
  • a choice of a SSK or NN
  • usual care

The pre-invitation leaflet and offer of online booking were found to be ineffective when compared to uptake in the control practices at 3 months.

Interestingly, it was found that women who had been vaccinated for human papillomavirus had a higher uptake rate at three months. Of the non-attenders, those receiving an SSK or a timed appointment were significantly more likely to take up screening (21.3 % and 19.8%) by 12 months than those in the usual care group.

A health economic analysis demonstrated these interventions were cost effective. The other interventions were ineffective.


Kitchener HC, Gittins M, Rivero-Arias O et al (2016) Health Technology Assessment. 20 (68) 1-138. doi: 10.3310/hta20680

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