The use of behavioural sciences in targeted health messages to improve the participation in cervical and breast screening programmes

The aim of this thesis was to examine the effects of behaviourally informed interventions deployed in text message reminders and invitation letters on the participation in cervical and breast cancer screening. Cancer screening saves lives through detecting cancer or precancerous changes early, when medical intervention is more likely to reduce morbidity and mortality. A key factor in the success of any screening programme is public participation. Although some individuals may object to cancer screening, evidence suggests that public support for cancer screening provision in the UK is above 90%. Yet despite this, participation rates across all three cancer screening programmes (breast, cervical and colorectal) remain lower than expected given reported intentions. This thesis explores the role of decision making – both reflective and automatic in the context of cancer screening behaviour and highlights the potential for the application of behavioural economic theory and behavioural science to inform intervention design aimed at increasing cancer screening uptake. Through the application of frameworks informed by behaviour change theory, three randomised controlled trials were designed to test the impact of behavioural interventions on participation rates in regional cervical and breast cancer screening programmes within the London area. The intervention design of each trial focused on the message content within either text message reminders or invitation letters. The first randomised controlled trial (RCT) tested different behaviourally-informed invitation letters in cervical screening and found that a shortened letter that contained a loss framed message has a small but significant positive impact on cervical screening rates. The second RCT tested different text message reminder content against a no-text message control and found that text message reminders can improve participation in cervical cancer screening. However, the content of such text message reminders further affects screening participation behaviour. The final RCT tested the effect different behaviour message content in text message reminders for timed appointments in the breast screening programme. No significant difference in breast screening participation was noticed as a result of the message content within text message reminders. However, due to logistical barriers encountered during the trial, which included a reconfiguration of regional screening services, this study had to be closed early, prior to the sample size being reached and was therefore underpowered. This research highlights the importance of the message content within health communications in cancer screening to improve participation rates. Exploratory subgroup analyses within these trials, indicates that different subgroups of women with common characteristics such as age, level of deprivation or previous exposure to cancer screening affected which message content was most effective and improving cancer screening participation.Open Acces