INSIGHT – Increasing Screening In Groups Hard to Reach with Targeting: Increasing the uptake of national screening programmes with smart targeting of low-uptake subgroups
Uptake of cervical and lung cancer screening
This is a three-arm implementation trial with a quantitative evaluation using a randomised, parallel-arm design. Participants across the three arms will receive different invitation strategies. In Arm 1 (Usual Care), participants will receive NHS screening invitations through standard GP or national processes. In Arm 2 (Appt Standard), participants will receive standardised and structured invitations via NHS App notifications, emails, SMS, or letters, including a direct booking link and reply-to-book SMS options. Letter invitations will ask participants to call their GP practice to book an appointment. In Arm 3 (Appt Targeted), participants will receive personalised messages designed to address specific barriers, in addition to the Appt Standard booking structure. Participants eligible to receive targeted interventions in Arm 3 will be selected according to additional criteria, such as preferred language, ethnicity, age, and Index of Multiple Deprivation (IMD). Remaining participants in Arm 3 (i.e. those not belonging to any pre-defined underserved, low-uptake subgroups) will receive the Appt Standard invitation strategies. The Appt Standard invitation process for cervical screening includes four sequential contact rounds: 1. NHS App Notification – A personalised invitation is sent via the NHS App with a booking link (URL), enabling patients to book their own appointments directly. 2. NHS Email Invitation – Patients who have not yet responded receive a “NHS NoReply” email invitation, again including a booking link allowing self-selection of available appointments. 3. Accessible SMS invitation – Patients who do not respond to the first two rounds are sent an accessible SMS message from Appt Health offering three well-spaced appointment options, with an ABC reply system (Patients can respond “A”, “B”, or “C” to book the corresponding slot). Or respond with the keyword “MORE” to request more options. 4. SMS Booking link – A final SMS invitation is sent to patients who
1. Registered with a participating GP practice. 2. Eligible for one of the NHS cancer screening programmes: For cervical cancer screening: 1. Aged 25–64 years 2. Have a cervix 3. Only individuals who have not responded to their initial national cervical screening invitation will be included For lung cancer screening: 1. Aged 55–74 years 2. Current or former smokers 3. All eligible individuals invited through the NHS lung cancer screening programme Targeted subgroups The targeted subgroups have been selected following a literature review and analysis of Fingertips data (https://fingertips.phe.org.uk/). The targeted subgroups for cervical screening include: 1. Women/People with a cervix with learning disabilities 2. Women/People with a cervix aged 25–34 years 3. Women/People with a cervix whose preferred language is not English 4. Women/People with a cervix aged 45–64 years living in more deprived areas For lung screening, the targeted subgroups are current smokers and former smokers living in more deprived areas.
1. Not eligible for cervical or lung cancer screening based on NHS programme criteria 2. Not registered with a participating GP practice