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The determinants of screening uptake and interventions for increasing uptake: A systematic review

Évaluation de la qualité de la recension: 9 (Rigoureuse) - Voir l'outil de validation

Résumé:

OBJECTIVES: To carry out a systematic review to examine factors associated with the uptake of screening programmes and to assess the effectiveness of methods used to increase uptake. In particular, the following questions were addressed: What factors (i.e. determinants) were associated with uptake of screening for different diseases; what interventions were shown to increase uptake of screening programmes (or informed uptake) within populations?
METHODS: Twenty-three databases of both published and grey literature were searched using strategies designed specifically for each database. Additional references were located through searching the bibliographies of related papers and contacting specialists in the subject area of the review. All published and unpublished studies were assessed for inclusion and there were no language restrictions. Studies of any screening programmes where the
outcome was screening uptake were assessed for inclusion. Randomised controlled trials (RCTs), quasi-RCTs, cohort studies and case–control studies (only when there was a prospective time barrier between collecting information about the determinants being assessed and the uptake of screening) were included in the determinants part of the review. In addition, only studies using some form of multivariate analysis were included. RCTs, quasi-RCTs and controlled trials were included in the interventions part of the review.
DATA EXTRACTION: One reviewer screened the titles and abstracts of 46,000 studies and a second reviewer checked a random sample (5%) of included and excluded papers. Studies were independently pre-screened for relevance (using the full paper copy) by two reviewers. Data were then extracted from relevant studies by one reviewer and checked by a second reviewer. Any disagreements at any stage were resolved through discussion with a third reviewer. Information was also recorded for each study relating to five items of methodological quality forthe determinants part of the review, and seven items for the interventions part of the review. These quality criteria were not used to obtain an overall quality score, but are reported descriptively in the text.
DATA SYNTHESIS: Data reporting the relationship between each determinant and screening uptake were extracted where possible and reported in a narrative. For intervention studies, relative risks and 95% confidence intervals (CI) were calculated for all appropriate RCTs (if enough data were available) using a random-effects model. A test for heterogeneity was performed for all sets of comparisons and there was
significant statistical heterogeneity for all but one of the comparisons. The results for the rest of the comparisons were reported in a narrative with diagrams displaying the relative risks (95% CI) for each RCT.
DISCUSSION and CONCLUSIONS: Sixty-five per cent of intervention studies and 82% of determinant studies were undertaken in the USA or Canada. Both these countries differ from the UK in the recommended ages and intervals for screening and in the organisation of screening programmes. While some of these factors may limit the generalisability of findings to the UK setting, they still provide a useful insight into screening behaviour.
IMPLICATIONS for PRACTICE: The authors identified a number of implications for practice arising from this review, and it is important to consider the findings in two ways: in relation to actual uptake and in relation to informed uptake. Any attempts to increase the uptake of screening should be pursued alongside initiatives to increase informed uptake.

Adresse: NHS Center for Reviews and Dissemination, University of York, UK.

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