Should a targeted communication strategy vs. a general communication strategy be used for socially disadvantaged women?

The conditional recommendation (rather than strong) in favour of using a targeted communication strategy instead of a general communication strategy to improve participation in screening programmes of socially disadvantaged women between the ages of 50 and 69, is the result of a moderate increase in participation rates that probably favours the intervention, in the context of low certainty of the evidence about these effects.

Consensus was reached by the GDG. However, one patient representative, Sue Warman, later during the GDG meeting expressed a lack of support for this recommendation.

• The GDG emphasises that for implementing this recommendation, it should be considered that the ECIBC's GDG already issued a strong recommendation for using letters, over no invitation, for inviting asymptomatic women.
• Furthermore, it is noted that for age groups where the recommendation made by the GDG for screening is conditional (45-49 and 70-74 age groups) informed decision-making is crucial for implementation, and there would be concern about increasing inappropriate screening. Where the GDG made a strong recommendation for screening in women between the ages of 50 and 69, this intervention is recommended as this intervention is desirable to increase participation in screening.
• Baseline participation rate: if the baseline participation rate for socially disadvantaged women is already low, the GDG notes that this intervention will have a small impact on increasing participation rates.
• The GDG noted that avoidance of stigma is important for screening programmes targeting socially disadvantaged women.
• The GDG noted that this population would need to first be identified in a feasible manner in order to target communication.
• Access to phone numbers for socially disadvantaged women may impact feasibility of this intervention if targeted communication is conducted by phone. The GDG notes that consideration of the invitation process in the screening programmes must be considered to assess the feasibility of targeting socially disadvantaged women.

• The GDG suggests that health providers analyse the distribution of test coverage in order to identify the socially disadvantaged women who need to be targeted.
• The GDG notes that effectiveness outcomes are an important monitoring and evaluation focus.

• The GDG suggests additional research on important patient outcomes, including informed decision making, satisfaction and the potential undesirable effects of targeted communication for socially disadvantaged women.
• The GDG notes that there is incongruity with the research evidence that was found for these interventions. A randomised control trial (RCT) comparing a tailored communication intervention to a general communication strategy favoured the general communication strategy, while another RCT comparing a different tailored strategy to targeted strategy favoured the tailored communication strategy. For this reason the GDG notes that, many factors impact the success of targeted and tailored invitations and, depending on the type of tailored intervention, participation of socially disadvantaged women in screening programmes may actually increase or decrease.
• Further research examining all types of interventions aimed at targeting or tailoring to socially disadvantaged women is suggested.