Cancer Screening: Small Media Targeting Clients — Cervical Cancer

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends interventions that use small media based on strong evidence of their effectiveness in increasing cervical cancer screening by Pap test.

The full CPSTF Finding and Rationale Statement and supporting documents for Cancer Screening: Small Media Targeting Clients — Cervical Cancer are available in The Community Guide Collection on CDC Stacks.

Intervention

Small media include videos and printed materials such as letters, brochures, and newsletters. These materials can be used to inform and motivate people to be screened for cancer. They can provide information tailored to specific individuals or targeted to general audiences.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 12 studies (search period 1966–2004). The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control.

Study Characteristics

  • Reviewed studies were conducted in both rural and urban communities and among different racial, ethnic, and socioeconomic groups
  • Studies used personal checklists or record booklets to inform and prompt participants; videos in patient waiting areas with or without posters; mailed leaflets, brochures, letters; or a combination of mailed information in printed and video format

Summary of Results

Twelve studies qualified for the systematic review.

  • Proportion of study participants completing screening by Pap test: median increase of 4.5 percentage points (interquartile interval: 0.2 to 9.0 percentage points; 12 study arms)
  • Tailoring was either less effective or, at best, no more effective than untailored interventions (2 studies)

Summary of Economic Evidence

Five studies qualified for the review and reported a wide range of cost effectiveness estimates based on different metrics and assumptions.

Applicability

Findings should apply to a range of populations and settings, provided the intervention is appropriately adapted to the target population and delivery context.

Evidence Gaps

  • Does effectiveness of small media differ by choice of medium (e.g., letter, video, brochure, or Internet-delivered application), information source (e.g., personal physician, educator), or intensity or frequency of delivery?
  • What is the relative cost effectiveness of tailored versus untailored messages?
  • How does the effectiveness of interventions to increase community demand for screening vary with the health literacy of a target population or subpopulation?
  • How can newer methods of communication including automated telephone calls and Internet-delivered applications be used to improve delivery, acceptance, and effectiveness of these interventions?
  • What is required to disseminate and implement effective interventions in community settings across the United States?
  • How can or should these approaches be applied to assure that screening, once initiated, is maintained at recommended intervals?
  • With respect to interventions that may be tailored to individuals, how are effective tailoring programs adapted, disseminated, and implemented in community-based settings across the United States?

Implementation Considerations and Resources

  • Primary barriers to implementing a small media intervention include limited resources and infrastructure
  • Access to effective marketing strategies, educational messages, and instructional materials (particularly for specific subgroups) may be limited by cost and special skills required to develop and test these messages
  • Materials libraries (such as those available at National Cancer Institute’s Evidence-Based Cancer Control Programs) are a potential source of high quality, topic- and population-specific messages developed as components of evidence-based programs
  • Production and dissemination of tailored messages may be more costly and resource intensive than untailored programs because tailoring generally requires new data collection, development of extensive message libraries with graphics, and computer programming support to ensure appropriate individualization
    • Cost effectiveness may improve through economies of scale
    • Web-based tailored intervention programs may provide a good solution to both the cost and complexity of developing and delivering tailored interventions to promote cancer screening
  • Recruitment, training, and support of community health workers and other interventionists to deliver educational messages may pose substantial barriers in smaller community or free-standing clinical settings
    • Regional or other aggregations of populations and services might be considered as strategies to overcome this problem

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