2. Materials and Methods
cervical cancer
CERVICAL CANCER
This project consisted of a small, randomised trial of reminder letters vs. phone calls/SMS for routine cervical screening testing in an ACCHO in NSW.Eligible clients included women aged 25–74, who were regular clients at the ACCHO who had presented for any condition in the previous three years, and who were eligible for cervical cancer screening. Exclusions included women who had had recent abnormal screening results and were referred for gynaecological follow-up, for example, for colposcopy. Women who had had a hysterectomy and no longer required cervical screening were excluded. (Refer to Using the electronic medical record software, Communicare [For the purpose of the trial, data was entered manually into an Excel spreadsheet, and stored in a password-locked, secure server with back-up. Participants were given a study identification number, which was stored in a separate secure file. The sample size was not calculated prior to commencement as this study was limited by the available sample size within this service. Randomisation was undertaken using an online randomising program, and participants were randomised to each arm in a 1:1 ratio. One arm received a reminder letter, followed by two further reminder letters unless an appointment was booked, and the other arm received a phone call, then two SMS, unless an appointment was booked. Women who were eligible for self-collect cervical cancer screening (women over 30, who were at least two years overdue for screening, who had declined speculum collection, and who had no recent abnormal tests) were mailed or verbally given additional information about options for self-collection. At the time of the trial, self-collection was only available for this subset of women.The cervical screening was delivered by female staff, including AHWs and Aboriginal nurses, with emphasis on making care accessible, for example, by providing free transport. Incentives were offered to women for participating in ‘Women’s Business’ or other preventive care, such as the annual preventive health assessment available to Aboriginal or Torres Strait Islander participants, for example, gifts or T-shirts. As part of routine care, women with abnormal results were followed as per national guidelines, for example, to discuss the results and then refer for colposcopy. Abnormal results were delivered via the recall system; that is, to provide at least three attempts at contacting those with abnormal results, all documented in the electronic medical record.Analysis was undertaken, first with descriptive statistics (demographics, previous number of reminders, previous abnormalities), then using SPSS for calculation of correlation of reminder type versus presentation for cervical screening. The outcome for measurement included completion of cervical screening within three months of the first reminder. Secondary outcomes included the presence of HPV or cervical abnormalities.Consumer feedback was gathered informally through program feedback forms. Ethics approval was given by the AHMRC ethics committee (1420/18), following support of the project by the ACCHO. A waiver of consent was allowed, as these activities constituted a part of routine service delivery, and both modes of reminder were already being used. The trial was registered (ACTRN12618001652268). 