Stepwise Strategy to Improve CANcer Screening Adherence: Cervical Cancer

The secondary objectives will be the following:

• To test the non-inferiority of interventions based on step 1a and step 1 (1a+1b), considering a non-inferiority limit of 5%;
• To test the superiority of the specific components of the multistage intervention corresponding to step 2 and step 3;
• To quantify the differences in adherence to cervical cancer screening, for interventions based on step 1 (1a+1b) and multistage interventions based on steps 1 and 2 and steps 1 to 3, between:

• Urban and rural areas;
• Younger and older population;
• Deprived and wealthy population;
• Never vs. ever users of screening;
• History of regular vs. irregular participation in screening programs.
• To quantify the differences in adherence to cervical cancer screening when using a positive or a neutral content of text messages and automatic phone calls, in step 1;
• To estimate the proportion of women who were performing cervical cancer screening in private health care services who started to be screened in an organized cervical cancer screening program, after a nurse face-to-face appointment at their primary care unit.

Intention-to-treat analysis will be used as primary strategy for all comparisons between interventions and control. Secondary per-protocol analysis will also be conducted. Binary logistic regression may be used to control for confounding, or in secondary analyses of the isolate effects of steps 1a, 2 and 3.

Inclusion criteria

• Women aged between 25 and 49 years
• Medical registration at any of the primary health care units selected for this study
• Eligible for cervical cancer screening*

• *Defined as all women aged between 25 and 60 years old who do not verify any of the following criteria: hysterectomized, active cervical cancer disease, currently undergoing cervical cancer treatment or did not start sexual activity.

Exclusion criteria

• Unavailability of mobile phone number