Cervical cancer screening: a comparison of recruitment strategies among older women

OBJECTIVE: To compare the effectiveness of different recruitment strategies in encouraging older women to have a Papanicolaou (Pap) test. DESIGN: A 2 x 2 factorial study. SETTING: Two rural areas of Victoria, Australia. PARTICIPANTS: A total of 10,620 persons aged between 40 and 69 years and designated as female on electoral lists. INTERVENTIONS: A personal letter of invitation and a community-based campaign of 4 weeks' duration alone and in combination. A control group received no active intervention. OUTCOME MEASURE: The proportion of eligible women having a Pap test report issued by the Victorian Cytology Service during the 12 weeks after the intervention compared with the 12 weeks before the intervention, with an intervening two-week washout period. RESULTS: The odds ratio of an eligible woman being screened during the intervention period relative to the pre-intervention period was 3.00 for women who were exposed to the campaign and sent the letter of invitation (95% confidence interval, 2.38-3.77, P less than 0.001), 1.86 for women who were exposed to the campaign (95% confidence interval, 1.49-2.33, P less than 0.001), 1.61 for women who were sent the letter of invitation (95% confidence interval, 1.34-1.92, P less than 0.001). The baseline was a control group who received no active intervention. CONCLUSIONS: Both personal invitation letters and community-based campaigns are effective in recruiting women for Pap test screening. Combined strategies are more effective than single strategies.