Effects of Telephone Intervention and Nudging Information on Cancer Screening Behavior
Effects of Telephone Intervention and Nudging Information on Cancer Screening Behavior: A Randomized Clinical Study
Objectives: Telephone interventions are often delivered to promote cancer screening for early detection and treatment. However, the effects of nudging information provided in telephone interventions on cancer screening behavior remain unclear. Accordingly, this study investigated the effects of telephone-delivered nudging information regarding screening benefits and social norms on cancer screening behavior.
Methods: This randomized controlled trial included 1,200 community-dwelling individuals meeting screening criteria for colorectal, breast, cervical, or oral cancer. Participants were assigned to one of four groups: telephone benefits, telephone social norms, telephone reminder, and letter reminder. The dependent variable was cancer screening behavior within 6 months after the intervention.
Studieöversikt
Status
Betingelser
Studietyp
Inskrivning (Faktisk)
Fas
- Inte tillämpbar
Kontakter och platser
Studieorter
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Tainan, Taiwan, 701
- National Cheng Kung University
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Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
- Community-dwelling individuals who met the criteria for cancer screening outlined by the Health Promotion Administration under Taiwan's Ministry of Health and Welfare were recruited. Participants were required to have sufficient communication ability and the ability to receive a telephone interview.
- colorectal cancer: people aged 50 to 74 years who have not received a fecal occult blood test within the past 2 years;
- breast cancer: women aged 45 to 69 years or those aged 40 to 44 years with a family history of breast cancer who have not received a mammography within the previous 2 years;
- cervical cancer: women aged over 30 years who have not received a pap smear test within the past 3 years; and
- oral cancer: the general people aged over 30 years or indigenous residents of Taiwan aged over 18 years with a history of chewing betel nut or smoking who have not received an oral mucosal examination within the past 2 years.
Exclusion Criteria:
- This study did not consider individuals with severe cognitive impairment or a previous cancer diagnosis, as indicated by chart records.
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Undersökning
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Enda
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
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Experimentell: telephone benefits group
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In the intervention, participants were provided with three categories of information: (1) the reasons why they were receiving the information (delivered by telephone or letter), that is, information regarding the criteria they met, such as their age or lack of screening history within a certain time period; (2) reasons why they should undergo screening, including nudging information related to benefits or social norms; and (3) a description of how they could make cancer screening appointments. In the telephone benefits group, key information regarding the benefits of cancer screening was provided with consideration of the health belief model (Lau et al., 2020). |
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Experimentell: telephone social norms group
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In the intervention, participants were provided with three categories of information: (1) the reasons why they were receiving the information (delivered by telephone or letter), that is, information regarding the criteria they met, such as their age or lack of screening history within a certain time period; (2) reasons why they should undergo screening, including nudging information related to benefits or social norms; and (3) a description of how they could make cancer screening appointments. In the telephone social norms group, the following were provided with consideration of the theory of planned behavior (Ritchie et al., 2021). |
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Aktiv komparator: telephone reminder group
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In the intervention, participants were provided with three categories of information: (1) the reasons why they were receiving the information (delivered by telephone or letter), that is, information regarding the criteria they met, such as their age or lack of screening history within a certain time period; (2) reasons why they should undergo screening, including nudging information related to benefits or social norms; and (3) a description of how they could make cancer screening appointments. The telephone reminder group only received the first and third types of information. |
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Aktiv komparator: letter reminder group
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In the intervention, participants were provided with three categories of information: (1) the reasons why they were receiving the information (delivered by telephone or letter), that is, information regarding the criteria they met, such as their age or lack of screening history within a certain time period; (2) reasons why they should undergo screening, including nudging information related to benefits or social norms; and (3) a description of how they could make cancer screening appointments. The letter reminder group only received the first and third types of information. |
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
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Cancer behavior
Tidsram: From enrollment to the end of treatment at 6 months.
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The primary outcome is whether the participants completed cancer screening or not (yes or no) |
From enrollment to the end of treatment at 6 months.
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Publikationer och användbara länkar
Allmänna publikationer
- Hopewell S, Chan AW, Collins GS, Hrobjartsson A, Moher D, Schulz KF, Tunn R, Aggarwal R, Berkwits M, Berlin JA, Bhandari N, Butcher NJ, Campbell MK, Chidebe RCW, Elbourne D, Farmer A, Fergusson DA, Golub RM, Goodman SN, Hoffmann TC, Ioannidis JPA, Kahan BC, Knowles RL, Lamb SE, Lewis S, Loder E, Offringa M, Ravaud P, Richards DP, Rockhold FW, Schriger DL, Siegfried NL, Staniszewska S, Taylor RS, Thabane L, Torgerson D, Vohra S, White IR, Boutron I. CONSORT 2025 statement: updated guideline for reporting randomised trials. BMJ. 2025 Apr 14;389:e081123. doi: 10.1136/bmj-2024-081123.
- Klein, W. M. (2003). Self-prescriptive, perceived, and actual attention to comparative risk information. Psychology & Health, 18(5), 625-643. https://doi.org/10.1080/0887044031000118465
- Tsipa A, O'Connor DB, Branley-Bell D, Day F, Hall LH, Sykes-Muskett B, Wilding S, Taylor N, Conner M. Promoting colorectal cancer screening: a systematic review and meta-analysis of randomised controlled trials of interventions to increase uptake. Health Psychol Rev. 2021 Sep;15(3):371-394. doi: 10.1080/17437199.2020.1760726. Epub 2020 May 13.
- Singer E, Couper MP, Fagerlin A, Fowler FJ, Levin CA, Ubel PA, Van Hoewyk J, Zikmund-Fisher BJ. The role of perceived benefits and costs in patients' medical decisions. Health Expect. 2014 Feb;17(1):4-14. doi: 10.1111/j.1369-7625.2011.00739.x. Epub 2011 Nov 10.
- Ritchie D, Van den Broucke S, Van Hal G. The health belief model and theory of planned behavior applied to mammography screening: A systematic review and meta-analysis. Public Health Nurs. 2021 May;38(3):482-492. doi: 10.1111/phn.12842. Epub 2020 Nov 30.
- Ploug T, Holm S. Doctors, Patients, and Nudging in the Clinical Context--Four Views on Nudging and Informed Consent. Am J Bioeth. 2015;15(10):28-38. doi: 10.1080/15265161.2015.1074303.
- Oyalowo A, Forde KA, Lamanna A, Kochman ML. Effect of Patient-Directed Messaging on Colorectal Cancer Screening: A Randomized Clinical Trial. JAMA Netw Open. 2022 Mar 1;5(3):e224529. doi: 10.1001/jamanetworkopen.2022.4529.
- Nolan JM, Schultz PW, Cialdini RB, Goldstein NJ, Griskevicius V. Normative social influence is underdetected. Pers Soc Psychol Bull. 2008 Jul;34(7):913-23. doi: 10.1177/0146167208316691.
- Monticciolo DL, Malak SF, Friedewald SM, Eby PR, Newell MS, Moy L, Destounis S, Leung JWT, Hendrick RE, Smetherman D. Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging. J Am Coll Radiol. 2021 Sep;18(9):1280-1288. doi: 10.1016/j.jacr.2021.04.021. Epub 2021 Jun 19.
- Lin ML, Huang JJ, Li SH, Lee FH, Hou MF, Wang HH. Effects of different reminder strategies on first-time mammography screening among women in Taiwan. BMC Health Serv Res. 2020 Feb 12;20(1):114. doi: 10.1186/s12913-020-4948-6.
- Lau J, Lim TZ, Jianlin Wong G, Tan KK. The health belief model and colorectal cancer screening in the general population: A systematic review. Prev Med Rep. 2020 Oct 6;20:101223. doi: 10.1016/j.pmedr.2020.101223. eCollection 2020 Dec.
- Knudsen AB, Rutter CM, Peterse EFP, Lietz AP, Seguin CL, Meester RGS, Perdue LA, Lin JS, Siegel RL, Doria-Rose VP, Feuer EJ, Zauber AG, Kuntz KM, Lansdorp-Vogelaar I. Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force. JAMA. 2021 May 18;325(19):1998-2011. doi: 10.1001/jama.2021.5746.
- Klein WM, Stefanek ME. Cancer risk elicitation and communication: lessons from the psychology of risk perception. CA Cancer J Clin. 2007 May-Jun;57(3):147-67. doi: 10.3322/canjclin.57.3.147.
- Jasurda JS, Danieli R, Yamanaka B, Shaukat A. Telephone Reminders Improve Fecal Immunochemical Test Return Rates. Am J Gastroenterol. 2022 Sep 1;117(9):1536-1538. doi: 10.14309/ajg.0000000000001868. Epub 2022 Jun 10.
- Hofmann B, Stanak M. Nudging in screening: Literature review and ethical guidance. Patient Educ Couns. 2018 Sep;101(9):1561-1569. doi: 10.1016/j.pec.2018.03.021. Epub 2018 Mar 27.
- Davey C, White V, Gattellari M, Ward JE. Reconciling population benefits and women's individual autonomy in mammographic screening: in-depth interviews to explore women's views about 'informed choice'. Aust N Z J Public Health. 2005 Feb;29(1):69-77. doi: 10.1111/j.1467-842x.2005.tb00752.x.
- Champion VL, Christy SM, Rakowski W, Lairson DR, Monahan PO, Gathirua-Mwangi WG, Stump TE, Biederman EB, Kettler CD, Rawl SM. An RCT to Increase Breast and Colorectal Cancer Screening. Am J Prev Med. 2020 Aug;59(2):e69-e78. doi: 10.1016/j.amepre.2020.03.008.
- Bouvard V, Wentzensen N, Mackie A, Berkhof J, Brotherton J, Giorgi-Rossi P, Kupets R, Smith R, Arrossi S, Bendahhou K, Canfell K, Chirenje ZM, Chung MH, Del Pino M, de Sanjose S, Elfstrom M, Franco EL, Hamashima C, Hamers FF, Herrington CS, Murillo R, Sangrajrang S, Sankaranarayanan R, Saraiya M, Schiffman M, Zhao F, Arbyn M, Prendiville W, Indave Ruiz BI, Mosquera-Metcalfe I, Lauby-Secretan B. The IARC Perspective on Cervical Cancer Screening. N Engl J Med. 2021 Nov 11;385(20):1908-1918. doi: 10.1056/NEJMsr2030640. No abstract available.
- Blumenthal-Barby JS, Krieger H. Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy. Med Decis Making. 2015 May;35(4):539-57. doi: 10.1177/0272989X14547740. Epub 2014 Aug 21.
- Agide FD, Sadeghi R, Garmaroudi G, Tigabu BM. A systematic review of health promotion interventions to increase breast cancer screening uptake: from the last 12 years. Eur J Public Health. 2018 Dec 1;28(6):1149-1155. doi: 10.1093/eurpub/ckx231.
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