{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:13:59Z","timestamp":1771928039682,"version":"3.50.1"},"reference-count":31,"publisher":"BMJ","issue":"10","funder":[{"name":"ACeS Porto Ocidental"},{"name":"Instituto de Sa\u00fade P\u00fablica da Universidade do Porto"},{"name":"ACeS Mar\u00e3o e Douro Norte"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,8,21]]},"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Screening is highly effective for cervical cancer prevention and control. Population-based screening programmes are widely implemented in high-income countries, although adherence is often low. In Portugal, just over half of the women adhere to cervical cancer screening, contributing for greater mortality rates than in other European countries. The most effective adherence raising strategies are based on patient reminders, small\/mass media and face-to-face educational programmes, but sequential interventions targeting the general population have seldom been evaluated. The aim of this study is to assess the effectiveness of a stepwise approach, with increasing complexity and cost, to improve adherence to organised cervical cancer screening: step 1a\u2014customised text message invitation; step 1b\u2014customised automated phone call invitation; step 2\u2014secretary phone call; step 3\u2014family health professional phone call and face-to-face appointment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A population-based randomised controlled trial will be implemented in Portuguese urban and rural areas. Women eligible for cervical cancer screening will be randomised (1:1) to intervention and control. In the intervention group, women will be invited for screening through text messages, automated phone calls, manual phone calls and health professional appointments, to be applied sequentially to participants remaining non-adherent after each step. Control will be the standard of care (written letter). The primary outcome is the proportion of women adherent to screening after step 1 or sequences of steps from 1 to 3. The secondary outcomes are: proportion of women screened after each step (1a, 2 and 3); proportion of text messages\/phone calls delivered; proportion of women previously screened in a private health institution who change to organised screening. The intervention and control groups will be compared based on intention-to-treat and per-protocol analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study was approved by the Ethics Committee of the Northern Health Region Administration and National Data Protection Committee. Results will be disseminated through communications in scientific meetings and peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial number<\/jats:title>\n                    <jats:p>NCT03122275<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-017730","type":"journal-article","created":{"date-parts":[[2017,10,5]],"date-time":"2017-10-05T20:30:33Z","timestamp":1507235433000},"page":"e017730","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Stepwise strategy to improve Cervical Cancer Screening Adherence (SCAN-CC): automated text messages, phone calls and face-to-face interviews: protocol of a population-based randomised controlled trial"],"prefix":"10.1136","volume":"7","clinical-trial-number":[{"clinical-trial-number":"nct03122275","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9410-633X","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Firmino-Machado","sequence":"first","affiliation":[{"name":"EPIUnit\u2013Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, Porto, Portugal"},{"name":"Unidade de Sa\u00fade P\u00fablica, ACeS Porto Ocidental, Porto, Portugal"}]},{"given":"Romeu","family":"Mendes","sequence":"additional","affiliation":[{"name":"EPIUnit\u2013Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, Porto, Portugal"},{"name":"Unidade de Sa\u00fade P\u00fablica, ACeS Douro I - Mar\u00e3o e Douro Norte, Vila Real, Portugal"},{"name":"Universidade de Tr\u00e1s os Montes e Alto Douro, Vila Real, Portugal"}]},{"given":"Am\u00e9lia","family":"Moreira","sequence":"additional","affiliation":[{"name":"Unidade de Sa\u00fade P\u00fablica, ACeS Porto Ocidental, Porto, Portugal"}]},{"given":"Nuno","family":"Lunet","sequence":"additional","affiliation":[{"name":"EPIUnit\u2013Instituto de Sa\u00fade P\u00fablica, Universidade do Porto, Porto, Portugal"},{"name":"Faculdade de Medicina da Universidade do Porto, Porto, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2017,10,5]]},"reference":[{"key":"2025121409154878000_7.10.e017730.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31012-1"},{"key":"2025121409154878000_7.10.e017730.2","unstructured":"WHO. Cancer Control - Early detection. 2007:1\u201350."},{"key":"2025121409154878000_7.10.e017730.3","unstructured":"IARC. Cervical Cancer and Screening, Chapter 1. In: IARC Handbook of Cancer Prevention, 2005;10."},{"key":"2025121409154878000_7.10.e017730.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17398-4"},{"key":"2025121409154878000_7.10.e017730.5","unstructured":"Portuguese Directorate-General of Health. Avalia\u00e7\u00e3o e Monitoriza\u00e7\u00e3o dos Rastreios Oncol\u00f3gicos Organizados de Base Populacional de Portugal Continental 2014."},{"key":"2025121409154878000_7.10.e017730.6","doi-asserted-by":"crossref","unstructured":"Oliveira M , Peleteiro B , Lunet N . Cytology use for cervical cancer screening in Portugal : results from the 2005 \/ 2006 National Health Survey. Eur J Public Health 2013:1\u20136.","DOI":"10.1093\/eurpub\/ckt077"},{"key":"2025121409154878000_7.10.e017730.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2012.12.027"},{"key":"2025121409154878000_7.10.e017730.8","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.85.6.834"},{"key":"2025121409154878000_7.10.e017730.9","first-page":"521","article-title":"Effectiveness of a call\/recall system in improving compliance with cervical cancer screening: A randomized controlled trial","volume":"157","author":"Buehler","year":"1997","journal-title":"Cmaj"},{"key":"2025121409154878000_7.10.e017730.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-842X.2005.tb00753.x"},{"key":"2025121409154878000_7.10.e017730.11","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1158\/1055-9965.346.13.3","article-title":"Wilander E. A Large Population-Based Randomized Controlled Trial to Increase Attendance at Screening for Cervical Cancer","volume":"13","author":"Eaker","year":"2004","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2025121409154878000_7.10.e017730.12","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1089\/154099903322447756","article-title":"The safety net: a cost-effective approach to improving breast and cervical cancer screening","volume":"12","author":"Tm","year":"2003","journal-title":"J Women\u2019s Heal"},{"key":"2025121409154878000_7.10.e017730.13","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2008.077636"},{"key":"2025121409154878000_7.10.e017730.14","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.27985"},{"key":"2025121409154878000_7.10.e017730.15","doi-asserted-by":"crossref","unstructured":"Women L , Randomized A , Trial C , et al . Telephone Care Management To Improve Cancer Screening among low-income women. Ann Intern Med 2006:563\u201371.","DOI":"10.7326\/0003-4819-144-8-200604180-00006"},{"key":"2025121409154878000_7.10.e017730.16","first-page":"1","article-title":"Cost Effective Analysis of Recall Methods for Cervical Cancer Screening in Selangor - Results from a Prospective Randomized Controlled Trial","volume":"15","author":"Marhayu","year":"2014","journal-title":"Asian Pac J Cancer Prev"},{"key":"2025121409154878000_7.10.e017730.17","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/10.1.5"},{"key":"2025121409154878000_7.10.e017730.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0738-3991(98)00122-0"},{"key":"2025121409154878000_7.10.e017730.19","first-page":"670","article-title":"A Randomized Controlled Trial of Interventions to Promote Cervical Cancer Screening Among Chinese Women in North America","volume":"94","author":"Taylor","year":"2002","journal-title":"CancerSpectrum Knowl Environ"},{"key":"2025121409154878000_7.10.e017730.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.302.6780.833"},{"key":"2025121409154878000_7.10.e017730.21","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/24.4.299"},{"key":"2025121409154878000_7.10.e017730.22","doi-asserted-by":"publisher","DOI":"10.1006\/pmed.2001.0949"},{"key":"2025121409154878000_7.10.e017730.23","doi-asserted-by":"crossref","unstructured":"Baron RC , Rimer BK , Breslow RA , et al . Client-Directed Interventions to Increase Community Demand for Breast, Cervical, and Colorectal Cancer Screening - A systematic review. Am J Prev Med 2008;35.","DOI":"10.1016\/j.amepre.2008.04.002"},{"key":"2025121409154878000_7.10.e017730.24","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12503"},{"key":"2025121409154878000_7.10.e017730.25","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cml044"},{"key":"2025121409154878000_7.10.e017730.26","doi-asserted-by":"publisher","DOI":"10.1007\/s13142-011-0021-7"},{"key":"2025121409154878000_7.10.e017730.27","doi-asserted-by":"crossref","unstructured":"Posadzki P , Mastellos N , Ryan R , et al . Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane database Syst Rev 2016;2016.","DOI":"10.1002\/14651858.CD009921.pub2"},{"key":"2025121409154878000_7.10.e017730.28","unstructured":"Hidalgo JL , S\u00e1nchez MP , Rabanales J , et al . Effectiveness of three interventions in improving adherence to cervical cancer screening. 2015:1\u20137."},{"key":"2025121409154878000_7.10.e017730.29","unstructured":"Project F , Paskett ED , Tatum CM , et al . Community-based Interventions to Improve Breast and Cervical Cancer Screening : Results of the Forsyth County Cancer Screening. 1999;8:453\u20139."},{"key":"2025121409154878000_7.10.e017730.30","unstructured":"Direct Extraction from SIARS software. 20\/09\/2016, at 14:00h."},{"key":"2025121409154878000_7.10.e017730.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-2466.2006.00290.x"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-017730","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T17:16:01Z","timestamp":1765732561000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-017730"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10]]},"references-count":31,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2017,10,5]]},"published-print":{"date-parts":[[2017,10]]}},"alternative-id":["10.1136\/bmjopen-2017-017730"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-017730","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10]]}}}