Design and implementation of novel behavioural science-informed interventions to facilitate screening uptake

Abstract

Breast screening saves 1300 lives annually, however, uptake in London remains below target. There are also disparities in attendance amongst several subgroups e.g. ethnic minorities, who could be considered underserved. Behavioural science is a field that can help understand the challenges to attendance and provide a means of developing behavioural change interventions.

This thesis aims to establish whether a behavioural science-informed intervention, designed with underserved communities, could significantly increase breast screening uptake.

The intervention, a novel animation delivered through a screening reminder SMS, encompassed several behavioural change techniques to address the determinants of non-attendance. The contents of both the SMS and animation were informed by an evidence-generating process. This included (1) a systematic review in which comparisons of the behavioural content of existing breast screening interventions was evaluated. (2) a modified Delphi process with screening experts to elicit the key aspects that need consideration when designing screening message interventions. (3) interviews and focus groups with representatives from underserved communities, to understand the specific barriers and facilitators they face.

Through a mapping and triangulation process, outputs from the evidence-generation were refined, and used to inform four co-design workshops. Participants representing underserved populations, community groups, and screening commissioners helped ideate, shape, and iterate the final intervention video and message.

The animation, sent via a behavioural science-informed SMS, was trialled against the current usual care message and video, and the existing video sent via the new behavioural SMS. Despite positive feedback, no significant difference in screening attendance was noted between the trial arms.

This research highlights the importance of an inclusive approach to intervention design and the need to use a multimodal approach to distribute screening information to achieve greater reach. However, more widespread infrastructural changes to the programme may be needed if the concerning decline in uptake is to be reversed.