Fifty percent of newly diagnosed cervical cancers are found among screening non-attenders. A quarter of Danish women do not attend screening; hence, the Copenhagen self-sampling initiative aimed to increase the screening coverage by offering non-attenders a Human Papillomavirus (HPV)-based self-sampling test. Women had to opt in by using conventional mail based response or one of the available electronic response methods including QR code mobile/web directed webpage, and e-mail. To understand the extent of acceptability of electronic communication platforms for opt-in strategies, we here describe the non-attenders by their screening history, participation rate and the usage of the different response methods.
In total, 23,362 non-attenders from the Capital Region were invited for participation. These women were not screened for at least one screening round, as ascertained through the national Pathology Data Bank. We determined the women’s responses in 7 months after the invitation. Women could order a self-sampling test via traditional response methods (regular mail, phone call) or via a webpage or email. The latter could be accessed directly or by use of supplied QR-code. Women were divided into two groups in line with their screening history: long-term unscreened women (no cytology sample registered in the last 10 or more years) and intermittently screened women (at least one cytology sample registered within the last 10 years but not within the last screening round). Pearson’s χ²- test was used to compare the differences in the responses and in participation by screening history and by response methods.
Of all invited women, 32% agreed to participate, and 20% returned the self-sampling test. The intermittently screened women were statistically more likely to return the test than the long-term unscreened women (36% vs. 24%, p<0.001). In total, 68% of all responses were received via regular mail or phone, and 32% via the webpage. Web-users were statistically more likely to opt in than regular mail users (98% vs 79%, p<0.001), but only slightly more likely to return the test (66% vs 63%, p=0.01).
Intermittently screened women were more likely to participate in self-sampling than long-time unscreened women. Other methods may be considered to reach out to the latter women, for instance a more targeted text in the invitation letter. Furthermore, women using modern technology platforms were more likely to participate than regular mail-users. Because of the lower cost of setting up technology-based systems than large scale use of regular mail service, electronic platforms should be considered in self-sampling using an opt-in strategy.