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

The conditional recommendation in favour of using either a tailored or targeted communication strategy to improve participation in screening programmes of socially disadvantaged women, was a result of a moderate increase in participation rates that probably favours the intervention, in the context of very low certainty of the evidence about these effects, together with the serious issues that may arise in implementing these strategies, and the assumed costs. However, the GDG agreed that other kind of tailored strategies different from those in the study examined need to be analysed.

The GDG noted that this recommendation is based on a single intervention from one randomised control trial (RCT), and there may be different effects with other tailored interventions.

The GDG made the following considerations:

• 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 between the ages of 50 and 69.
• 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.
• Regarding the baseline participation rate, if it is already low for socially disadvantaged women, this intervention would likely have a small impact on increasing participation rates.
• Avoidance of stigma is important for screening programmes targeting socially disadvantaged women.
• This population would first need to be identified in a feasible manner in order to target communication and the intervention evaluated in the single study identified is generally not feasible.
• Access to phone numbers for socially disadvantaged women may impact feasibility of this intervention if targeted communication is conducted by phone. The invitation process in the screening programmes must be considered to assess the feasibility of targeting socially disadvantaged women.

• The GDG considered that health providers should 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 noted 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.