- Email: [email protected]
Message framing in invitation letters for cervical screening: a randomised controlled trial
Meeting Abstracts
Message framing in invitation letters for cervical screening: a randomised controlled trial Sarah Huf, Dominic King, Sarah Honeywell, Fu-Min Tseng, Isabelle Andresen, Ivo Vlaev, Ara Darzi
Abstract Background Cervical screening saves 4500 lives in England annually and is offered nationally to women aged 24–64 years. A successful screening programme relies among other factors on uptake by the at-risk population. National coverage fell from 80·3% in 2005 to 77·2% in 2015. How health information is framed, in terms of potential gains (eg, lives saved) versus losses (eg, lives lost) of taking part in screening, can affect uptake. This study aimed to investigate the effect of framing in invitation letters for cervical screening on attendance in a low uptake urban area of London. Methods In a randomised controlled trial, two simplified invitation letters were compared with the existing invitation letter (control). Women living in the trial area, who were due for screening between Oct 21 and Dec 16, 2015, were randomised to receiving a gain framed message, a loss framed message, or the existing invitation letter (1:1:1, by computer-generated random number). Participants but not investigators were masked to allocation. Primary outcome was attendance for cervical screening at 15 and 32 weeks. Association between framing and attendance was measured with logistic regression. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN93653543. Findings 6223, 6223, and 6202 women were allocated to the control, gain framed, and loss framed groups, respectively. Mean age was 35·4 years (SD 9·9). Median number of invitations previously received was 4 (IQR 2–6) and past attendances was 1 (0–4). At 15 weeks no significant difference in uptake between the groups was found. Attendance at 32 weeks was 32·7% (n=2032) in the control compared with 32·3% (2011) in the gain framed group and 33·5% (2079) in the loss framed group. Logistic regression showed a significant increase in uptake in the loss framed group (adjusted odds ratio 1·1, 95% CI 1·0–1·21; p=0·04). No adverse events were observed.
Published Online November 25, 2016 Department of Surgery and Cancer, St Mary’s Campus, Imperial College London, London, UK (S Huf MBBS, D King MBChB, F-M Tseng PhD, A Darzi MD); Citizen Insight and Behavioural Insight, Department of Health, London, UK (S Honeywell MSc); Behavioural Insights Team, London, UK (I Andresen BSc); and Warwick Business School, Warwick, UK (I Vlaev DPhil) Correspondence to: Miss Sarah Huf, Department of Surgery and Cancer, St Mary’s Campus, Imperial College London, London W2 1NY, UK [email protected]
Interpretation Overall, the use of loss framing in invitation letters for cervical screening can increase the uptake of cervical screening at little or no extra cost. This study highlights one example of how information in invitation letters can be made more salient. Further research to explore these techniques is required. How changes in content might affect uptake is difficult to predict, so further trials in diverse populations are needed to ensure that new interventions are effective and not detrimental to uptake. Funding Department of Health. Contributors SHu contributed to concept and designed the intervention, performed data analysis and interpretation, and drafted the abstract. DK contributed to intervention design and critically reviewed data analysis and abstract. SHo contributed to design intervention, trial set-up, and critically reviewed the abstract. FT critically reviewed the data analysis and interpretation of results and abstract drafting. IA contributed to designed interventions and trial setup. IV critically reviewed data analysis and interpretation and critically reviewed the abstract. AD critically reviewed data analysis and abstract. Declaration of interests We declare no competing interests. Acknowledgments We thank Tim Chadborn for his contribution to the review and interpretation of the data analysis.
www.thelancet.com
57
Message framing in invitation letters for cervical screening: a randomised controlled trial Sarah Huf, Dominic King, Sarah Honeywell, Fu-Min Tseng, Isabelle Andresen, Ivo Vlaev, Ara Darzi
Abstract Background Cervical screening saves 4500 lives in England annually and is offered nationally to women aged 24–64 years. A successful screening programme relies among other factors on uptake by the at-risk population. National coverage fell from 80·3% in 2005 to 77·2% in 2015. How health information is framed, in terms of potential gains (eg, lives saved) versus losses (eg, lives lost) of taking part in screening, can affect uptake. This study aimed to investigate the effect of framing in invitation letters for cervical screening on attendance in a low uptake urban area of London. Methods In a randomised controlled trial, two simplified invitation letters were compared with the existing invitation letter (control). Women living in the trial area, who were due for screening between Oct 21 and Dec 16, 2015, were randomised to receiving a gain framed message, a loss framed message, or the existing invitation letter (1:1:1, by computer-generated random number). Participants but not investigators were masked to allocation. Primary outcome was attendance for cervical screening at 15 and 32 weeks. Association between framing and attendance was measured with logistic regression. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN93653543. Findings 6223, 6223, and 6202 women were allocated to the control, gain framed, and loss framed groups, respectively. Mean age was 35·4 years (SD 9·9). Median number of invitations previously received was 4 (IQR 2–6) and past attendances was 1 (0–4). At 15 weeks no significant difference in uptake between the groups was found. Attendance at 32 weeks was 32·7% (n=2032) in the control compared with 32·3% (2011) in the gain framed group and 33·5% (2079) in the loss framed group. Logistic regression showed a significant increase in uptake in the loss framed group (adjusted odds ratio 1·1, 95% CI 1·0–1·21; p=0·04). No adverse events were observed.
Published Online November 25, 2016 Department of Surgery and Cancer, St Mary’s Campus, Imperial College London, London, UK (S Huf MBBS, D King MBChB, F-M Tseng PhD, A Darzi MD); Citizen Insight and Behavioural Insight, Department of Health, London, UK (S Honeywell MSc); Behavioural Insights Team, London, UK (I Andresen BSc); and Warwick Business School, Warwick, UK (I Vlaev DPhil) Correspondence to: Miss Sarah Huf, Department of Surgery and Cancer, St Mary’s Campus, Imperial College London, London W2 1NY, UK [email protected]
Interpretation Overall, the use of loss framing in invitation letters for cervical screening can increase the uptake of cervical screening at little or no extra cost. This study highlights one example of how information in invitation letters can be made more salient. Further research to explore these techniques is required. How changes in content might affect uptake is difficult to predict, so further trials in diverse populations are needed to ensure that new interventions are effective and not detrimental to uptake. Funding Department of Health. Contributors SHu contributed to concept and designed the intervention, performed data analysis and interpretation, and drafted the abstract. DK contributed to intervention design and critically reviewed data analysis and abstract. SHo contributed to design intervention, trial set-up, and critically reviewed the abstract. FT critically reviewed the data analysis and interpretation of results and abstract drafting. IA contributed to designed interventions and trial setup. IV critically reviewed data analysis and interpretation and critically reviewed the abstract. AD critically reviewed data analysis and abstract. Declaration of interests We declare no competing interests. Acknowledgments We thank Tim Chadborn for his contribution to the review and interpretation of the data analysis.
www.thelancet.com
57