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BackgroundSocial media is commonly used in public health interventions to promote cancer screening and early diagnosis, as it can rapidly deliver targeted public health messages to large numbers of people. However, there is currently little understanding of the breadth of social media interventions and evaluations, whether they are effective, and how they might improve outcomes. ObjectiveThis scoping review aimed to map the evidence for social media interventions to improve cancer screening and early diagnosis, including their impact on behavior change and how they facilitate behavior change. MethodsFive databases and the grey literature were searched to identify qualitative and quantitative evaluations of social media interventions targeting cancer screening and early diagnosis. Two reviewers independently reviewed each abstract. Data extraction was carried out by one author and verified by a second author. Data on engagement was extracted using an adapted version of the key performance indicators and metrics related to social media use in health promotion. Insights, exposure, reach, and differing levels of engagement, including behavior change, were measured. The behavior change technique taxonomy was used to identify how interventions facilitated behavior change. ResultsOf the 23 publications and reports included, the majority (16/23, 70%) evaluated national cancer awareness campaigns (eg, breast cancer awareness month). Most interventions delivered information via Twitter (13/23, 57%), targeted breast cancer (12/23, 52%), and measured exposure, reach, and low- to medium-level user engagement, such as number of likes (9/23, 39%). There were fewer articles about colorectal and lung cancer than about breast and prostate cancer campaigns. One study found that interventions had less reach and engagement from ethnic minority groups. A small number of articles (5/23, 22%) suggested that some types of social media interventions might improve high-level engagement, such as intended and actual uptake of screening. Behavior change techniques, such as providing social support and emphasizing the consequences of cancer, were used to engage users. Many national campaigns delivered fundraising messages rather than actionable health messages. ConclusionsThe limited evidence suggests that social media interventions may improve cancer screening and early diagnosis. Use of evaluation frameworks for social media interventions could help researchers plan more robust evaluations that measure behavior change. We need a greater understanding of who engages with these interventions to know whether social media can be used to reduce some health inequalities in cancer screening and early diagnosis. International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2019-033592

Background: We assessed experiences of human papillomavirus (HPV) vaginal self‐sampling and future screening preferences in an ethnically and socio‐economically diverse group of women overdue for cervical screening. Setting and Participants: A postal questionnaire was embedded in the YouScreen self‐sampling trial in England: 32.5% (2712/8338) of kit completers returned the survey. Kit non‐completers were encouraged to return a questionnaire, but no responses were received. Participants were ethnically diverse (40.3% came from ethnic minority backgrounds), and 59.1% came from the two most deprived quintiles. Differences in confidence in kit completion, trust in the test results and intention to attend a follow‐up test if HPV‐positive were evaluated using Pearson's χ2 analyses. Binary logistic regression models explored predictors of a future screening choice and preferences for urine versus vaginal self‐sampling. Results: Most kit‐completers reported high confidence in self‐sampling (82.6%) and high trust in the results (79.9%), but experiences varied by ethnicity and screening status. Most free‐text comments were positive but some reported difficulties using the device, pain or discomfort. Most women would opt for self‐sampling in the future (71.3% vs. 10.4% for a clinician‐taken test) and it was more often preferred by ethnic minority groups, overdue screeners and never attenders. Urine self‐tests were preferred to vaginal tests (41.9% vs. 15.4%), especially among women from Asian, Black or Other Ethnic backgrounds. Conclusions: Kit‐completers were confident, found the test easy to complete, and trusted the self‐sample results. However, experiences varied by ethnic group and some women highlighted difficulties with the kit. Most women would prefer self‐sampling in the future, but it was not a universal preference, so offering a choice will be important. Patient or Public Contribution: We did not have direct patient and public involvement and engagement (PPIE) in the questionnaire design. However, patients and public representatives did input into the design of the YouScreen trial and reviewed the wider study materials (e.g. participant information sheet). Trial Registration: This questionnaire study was embedded in the YouScreen trial. The protocol for the YouScreen trial is available at https://www.isrctn.com/ISRCTN12759467. The National Institute for Health Research 43 Clinical Research Network (NIHR CRN) Central Portfolio Management System (CPMS) ID is 4441934. [ABSTRACT FROM AUTHOR]

Background: A risk-stratified breast screening program could offer low-risk women less screening than is currently offered by the National Health Service. The acceptability of this approach may be enhanced if it corresponds to UK women's screening preferences and values. Objectives: To elicit and quantify preferences for low-risk screening options. Methods: Women aged 40 to 70 y with no history of breast cancer took part in an online discrete choice experiment. We generated 32 hypothetical low-risk screening programs defined by 5 attributes (start age, end age, screening interval, risk of dying from breast cancer, and risk of overdiagnosis), the levels of which were systematically varied between the programs. Respondents were presented with 8 choice sets and asked to choose between 2 screening alternatives or no screening. Preference data were analyzed using conditional logit regression models. The relative importance of attributes and the mean predicted probability of choosing each program were estimated. Results: Participants (N = 502) preferred all screening programs over no screening. An older starting age of screening, younger end age of screening, longer intervals between screening, and increased risk of dying had a negative impact on support for screening programs (P < 0.01). Although the risk of overdiagnosis was of low relative importance, a decreased risk of this harm had a small positive impact on screening choices. The mean predicted probabilities that risk-adapted screening programs would be supported relative to current guidelines were low (range, 0.18 to 0.52). Conclusions: A deintensified screening pathway for women at low risk of breast cancer, especially one that recommends a later screening start age, would run counter to women's breast screening preferences. Further research is needed to enhance the acceptability of offering less screening to those at low risk of breast cancer. Highlights: Risk-based breast screening may involve the deintensification of screening for women at low risk of breast cancer. Low-risk screening pathways run counter to women's screening preferences and values. Longer screening intervals may be preferable to a later start age. Work is needed to enhance the acceptability of a low-risk screening pathway. [ABSTRACT FROM AUTHOR]

Objectives: Human papillomavirus (HPV) primary testing for cervical screening is being implemented around the world. We explored HPV awareness, and knowledge about primary screening in Great Britain (England, Scotland and Wales), where it has been in place for several years, ahead of extended screening intervals being implemented in England. Setting/Methods: Women aged 18–70 (n = 1995) were recruited by YouGov from their online panel in August 2022. The weighted sample (n = 1930) was population-representative by age, region, education and social grade. We measured HPV awareness, knowledge (excluding those unaware of HPV) using eight true/false items, and understanding of the role of HPV testing in cervical screening. Results: Overall, 77.6% (1499/1930) of women were aware of HPV. When asked to identify the statement describing how cervical screening works, only 12.2% (236/1930) correctly selected the statement reflecting HPV primary screening (13.5% (194/1436) in screening-eligible women). Excluding those unaware of HPV, most participants had heard about the virus in the context of cervical screening (981/1596; 61.5%) or HPV vaccination (1079/1596; 67.6%). Mean knowledge score was 3.7 out of 8 (SD = 2.2) in this group. Most knew that an HPV-positive result does not mean a woman will definitely develop cervical cancer (1091/1499; 72.8%) but far fewer were aware of the long timeline for HPV to develop into cervical cancer (280/1499; 18.7%). Conclusions: Only three-quarters of women in Britain are aware of HPV, and knowledge of primary screening is very low, even among screening-age women. This points to continued need for awareness-raising campaigns to ensure informed choice about screening and mitigate public concern when screening intervals are extended. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate psychological, social, and financial outcomes amongst individuals undergoing a non‐contrast abdominal computed tomography (CT) scan to screen for kidney cancer and other abdominal malignancies alongside the thoracic CT within lung cancer screening. Subjects and Methods: The Yorkshire Kidney Screening Trial (YKST) is a feasibility study of adding a non‐contrast abdominal CT scan to the thoracic CT within lung cancer screening. A total of 500 participants within the YKST, comprising all who had an abnormal CT scan and a random sample of one‐third of those with a normal scan between 14/03/2022 and 24/08/2022 were sent a questionnaire at 3 and 6 months. Outcomes included the Psychological Consequences Questionnaire (PCQ), the short‐form of the Spielberger State–Trait Anxiety Inventory, and the EuroQoL five Dimensions five Levels scale (EQ‐5D‐5L). Data were analysed using regression adjusting for participant age, sex, socioeconomic status, education, baseline quality of life (EQ‐5D‐5L), and ethnicity. Results: A total of 380 (76%) participants returned questionnaires at 3 months and 328 (66%) at 6 months. There was no difference in any outcomes between participants with a normal scan and those with abnormal scans requiring no further action. Individuals requiring initial further investigations or referral had higher scores on the negative PCQ than those with normal scans at 3 months (standardised mean difference 0.28 sd, 95% confidence interval 0.01–0.54; P = 0.044). The difference was greater in those with anxiety or depression at baseline. No differences were seen at 6 months. Conclusion: Screening for kidney cancer and other abdominal malignancies using abdominal CT alongside the thoracic CT within lung cancer screening is unlikely to cause significant lasting psychosocial or financial harm to participants with incidental findings. [ABSTRACT FROM AUTHOR]

Objective: Psychological distress after testing positive for human papillomavirus (HPV) at cervical cancer screening is well documented in the general population. However, little is known about the impact of an HPV‐positive result on those with pre‐existing mental health conditions, who may be at higher risk of experiencing clinically significant distress. This study explored the psychosocial impact of HPV in women with co‐morbid mental health conditions, as well as their experience of cervical screening during the COVID‐19 pandemic. Methods: Semi‐structured telephone interviews were conducted with 22 women aged 27–54 who had tested positive for HPV at routine cervical screening in England, and who reported having at least one mental health condition. Data were analysed using thematic analysis. Results: Being informed of an HPV‐positive result increased distress and heightened pre‐existing psychological challenges. Psychosocial response and duration of HPV‐related distress appeared to be influenced by the ability to regulate emotions, number of consecutive HPV‐positive results, interactions with health care professionals, and other life stressors. The experience added further complexity to many women's perceptions of self and self‐esteem. Women who had received psychological treatment for their mental health condition were best able to self‐manage HPV‐related distress by applying learned coping skills. Conclusions: Receiving an HPV‐positive result at cervical screening appears to be a distressing experience for women with co‐morbid mental health conditions. Future hypothesis‐driven research is needed to confirm findings and develop effective interventions to reduce psychosocial burden. [ABSTRACT FROM AUTHOR]

Background: Mode of access to primary care changed during the COVID-19 pandemic; remote consultations became more widespread. With remote consultations likely to continue in UK primary care, it is important to understand people's perceptions of remote consultations and identify potential resulting inequalities. Aim: To assess satisfaction with remote GP consultations in the UK during the COVID-19 pandemic and identify demographic variation in satisfaction levels. Design and setting: A cross-sectional survey from the second phase of a large UK-based study, which was conducted during the COVID-19 pandemic. Method: In total, 1426 adults who self-reported having sought help from their doctor in the past 6 months completed an online questionnaire (February to March 2021). Items included satisfaction with remote consultations and demographic variables. Associations were analysed using multivariable regression. Results: A novel six-item scale of satisfaction with remote GP consultations had good psychometric properties. Participants with higher levels of education had significantly greater satisfaction with remote consultations than participants with mid-level qualifications (B = −0.82, 95% confidence interval [CI] = −1.41 to −0.23) or those with low or no qualifications (B = −1.65, 95% CI = −2.29 to −1.02). People living in Wales reported significantly higher satisfaction compared with those living in Scotland (B = −1.94, 95% CI = −3.11 to −0.78), although caution is warranted due to small group numbers. Conclusion: These findings can inform the use and adaptation of remote consultations in primary care. Adults with lower educational levels may need additional support to improve their experience and ensure equitable care via remote consultations. [ABSTRACT FROM AUTHOR]

Objectives: Cervical screening uptake in England is falling. Infographics could strengthen intention to attend, increase positive attitudes and improve knowledge. Age targeting could improve these outcomes further. We tested the impact of generic and age‐targeted infographics. Design: A randomized controlled trial using an age‐stratified, parallel‐group design. Methods: Women aged 25–64 (n = 2095) were recruited through an online panel and randomized to see one of the three infographics. We tested: (i) impact of a generic cervical screening infographic compared to a control infographic on an unrelated topic with all screening age women and (ii) impact of an age‐targeted infographic compared to a generic cervical screening infographic with older women (50–64 years). Intentions, knowledge and attitudes were measured. Results: Women aged 25–64 years who viewed the generic infographic had significantly higher intentions [F(1, 1513) = 6.14, p =.013, ηp2 =.004], more accurate beliefs about the timeline of cervical cancer development (OR: 5.18, 95% CI: 3.86–6.95), more accurate social norms (OR: 3.03, 95% CI: 2.38–3.87) and more positive beliefs about screening benefits (OR: 2.23, 95% CI: 1.52–3.28) than those viewing the control infographic. In the older age group, there was no significant difference in intention between those viewing the generic versus age‐targeted versions [F(1, 607) =.03, p =.853, ηp2 <.001], but the age‐targeted version was more engaging [F(1, 608) = 9.41, p =.002, ηp2 =.015]. Conclusions: A cervical screening infographic can result in more positive attitudes and better knowledge and may have a small impact on intentions. Although age targeting did not affect intention, it had a positive impact on engagement and may therefore be useful in encouraging women to read and process materials. [ABSTRACT FROM AUTHOR]

Background and aims: Optimising smoking cessation (SC) referral strategies within lung cancer screening (LCS) could significantly reduce lung cancer mortality. This study aimed to measure acceptance of referral to SC support by either practitioner‐referral or self‐referral among participants attending a hospital‐based lung health check appointment for LCS as part of the Lung Screen Uptake Trial. Design: Single‐blinded two‐arm randomised controlled trial. Setting: England. Participants: Six hundred forty‐two individuals ages 60 to 75 years, who self‐reported currently smoking or had a carbon monoxide reading over 10 ppm during the lung health check appointment. Intervention and comparator: Participants were randomised (1:1) to receive either a contact information card for self‐referral to a local stop smoking service (SSS) (self‐referral, n = 360) or a SSS referral made on their behalf by the nurse or trial practitioner (practitioner‐referral, n = 329). Measurements The primary outcome was acceptance of the practitioner‐referral (defined as participants giving permission for their details to be shared with the local SSS) compared with acceptance of the self‐referral (defined as participants taking the physical SSS contact information card to refer themselves to the local SSS). Findings Half (49.8%) accepted the practitioner‐made referral to a local SSS, whereas most (88.5%) accepted the self‐referral. The odds of accepting the practitioner‐referral were statistically significantly lower (adjusted odds ratio = 0.10; 95% confidence interval = 0.06–0.17) than the self‐ referral. In analyses stratified by group, greater quit confidence, quit attempts and Black ethnicity were associated with increased acceptance within the practitioner‐referral group. There were no statistically significant interactions between acceptance by referral group and any of the participants' demographic or smoking characteristics. Conclusions: Among participants in hospital‐based lung cancer screening in England who self‐reported smoking or met a carbon monoxide cut‐off, both practitioner‐referral and self‐referral smoking cessation strategies were highly accepted. Although self‐referral was more frequently accepted, prior evidence suggests practitioner‐referrals increase quit attempts, suggesting practitioner‐referrals should be the first‐line strategy within lung cancer screening, with self‐referral offered as an alternative. [ABSTRACT FROM AUTHOR]