Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material, Telephone Support, Parent Engagement, Patient Reminder/Invitation

Intervention Description: This study aims to test the acceptability and feasibility of SmokefreeMOM, a national smoking cessation text-messaging program for pregnant smokers.

Intervention Results: Results indicate that the SmokefreeMOM program was highly rated overall and rated more favorably than the control condition in its helpfulness at 3-month follow-up (P<.01) and in its frequency of messaging at both 1-month and 3-month follow-ups (P<.001, P<.01, respectively). Despite the presence of technical problems, the vast majority of intervention participants read all program messages, and few participants unsubscribed from the program. There were no significant differences between groups on the use of extra treatment resources or on smoking-related outcomes. However, at the 3-month follow-up, some outcomes favored the intervention group.

Conclusion: SmokefreeMOM is acceptable for pregnant smokers. It is recommended that SmokefreeMOM be further refined and evaluated.

Study Design: RCT

Setting: Obstetrics-gynecology clinics

Population of Focus: Women who are currently pregnant, English proficient, with a mobile phone and unlimited text messaging, that are currently smoking or smoked in the past 2 weeks

Data Source: Surveys and saliva sample

Sample Size: 99 participants (55 in SmokefreeMOM intervention group and 44 in control group)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Telephone Support, Parent Engagement, Incentives

Intervention Description: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program.

Intervention Results: Most participants responded to the program favorably. Highly rated aspects included the content of the program, skills taught within the program, and encouragement and social support provided by the program. Participants reported that the program was helpful in quitting, that the program gave good ideas on quitting, and that they would recommend the program to a friend. Suggestions for improvement included increasing the message dose and making the quitpal more interactive.

Conclusion: This pilot test provides support for the feasibility and acceptability of Quit4baby. Future studies are needed to assess whether Quit4baby is effective for smoking cessation during pregnancy.

Study Design: Single group pre-post test evaluation pilot

Setting: Electronic phone application

Population of Focus: Women over 18 years of age who are currently pregnant, English proficient, that are currently smoking or smoked in the past 2 weeks

Data Source: Telephone surveys, retrospective computer records review of engagement with the technology

Sample Size: 20

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Parent Engagement, Telephone Support

Intervention Description: The study tests whether an interactive and intensive text messaging program, Quit4baby, can promote smoking cessation for pregnant women already enrolled in a health text messaging program, Text4baby.

Intervention Results: Using an intention-to-treat analysis, 28.80% of the intervention group and 15.79% of the control group reported not smoking in the past 7 days at 1 month (p<0.01), and 35.20% of the intervention group and 22.67% of the control group reported not smoking in the past 7 days at 3 months (p<0.01). Biochemical verification of smoking status at 3 months indicated no significant differences between groups (15.60% in the intervention group and 10.93% in the control group [p=0.13]), although significant differences favoring the intervention were found for older smokers (p<0.05) and for those who enrolled in their second or third trimester of pregnancy (p<0.05). Self-report of late pregnancy 7- and 30-day point prevalence abstinence favored the intervention group (p<0.001, p<0.01). No significant differences were observed at the 6-month follow-up or in the postpartum period.

Conclusion: Results provide limited support of the efficacy of the Quit4baby text messaging program in the short term and late in pregnancy, but not in the postpartum period.

Study Design: RCT

Setting: Electronic phone application

Population of Focus: Women over 14 years of age who are currently pregnant, English proficient, that are currently smoking or smoked in the past 2 weeks, who were signed up for Text4Baby message

Data Source: Surveys and saliva sample

Sample Size: 497

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Enabling Services

Intervention Description: Individually randomised controlled trial. All 3 124 women in three low-resource areas in Gothenburg, due for screening during the study period, were randomised to receive an offer of a free test or the standard invitation stating the regular fee of 100 SEK (≈11 €). The study was conducted during the first six months of 2013. Attendance was defined as a registered Pap smear within 90 days from the date the invitation was sent out.

Intervention Results: Attendance did not differ significantly between women who were charged and those offered free screening (RR 0.93; CI 0.85-1.02). No differences were found within the districts or as an effect of age, attendance after the most recent previous invitation or previous experience of smear taking.

Conclusion: Abolishment of a modest screening fee in socially disadvantaged urban districts with low coverage, after previous multiple systematic interventions, does not increase attendance in the short term. Other interventions might be more important for increasing attendance in low socio-economic status areas.

Study Design: RCT

Setting: Sweden

Population of Focus: Women with no Pap smear reported in the past 3 or 5 years

Data Source: Process Registry of the Swedish National Screening Registry

Sample Size: Total (N=3,124) Intervention (n=1,562); Control (n=1,562)

Age Range: 23-63

Intervention Components (click on component to see a list of all articles that use that intervention): Counseling (Parent/Family), Patient Reminder/Invitation,

Intervention Description: Patient navigators reviewed the electronic medical records and immunization registry records of eligible postpartum women to determine whether they needed to initiate or complete the human papillomavirus vaccine series. Eligible women were counseled and offered the human papillomavirus vaccine during their hospital stay. Patient navigators scheduled follow-up injections in addition to the mother's postpartum or her infant's well-child visits, made reminder phone calls, and rescheduled missed appointments

Intervention Results: Both the initial and expanded programs achieved vaccine completion rates above 70%. The detailed results are provided in the excerpt

Conclusion: Human papillomavirus vaccination on the postpartum unit is an effective way to increase catchup rates and is well accepted by healthcare providers. High completion rates can be achieved if adequate support is provided, even among patients residing in rural or underserved areas who need extensive support to access primary healthcare services. Although this particular program may be considered costly, it is overall effective because the vaccine prevents 5 different types of cancer in women. The inclusion of human papillomavirus vaccination in routine postpartum care is a relatively easy way to reach many adults not vaccinated at a younger age and could help address low vaccination rates among young women in the United States, including hard-to-reach populations.

Study Design: The study utilized a quantitative and qualitative evaluation to examine the success and limitations of the program when expanded from 1 county to 36 counties.

Setting: The setting of the study is not explicitly mentioned in the provided excerpts.

Population of Focus: The target audience includes postpartum women aged ≤26 years who delivered an infant at the public hospital.

Sample Size: The initial program enrolled 2631 eligible postpartum women, and the expanded program enrolled 4330 eligible postpartum women.

Age Range: The study targeted women aged ≤26 years.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Patient Reminder/Invitation,

Intervention Description: - The intervention consisted of three strategies: 1) a standardized vaccine policy change to include HPV vaccine with other adolescent vaccines, 2) sending pre-visit emails to parents of teens to provide factual vaccine information, and 3) implementing a provider communication initiative to ensure consistent messages and effective cancer prevention recommendations for HPV vaccination ,[object Object],, ,[object Object],.

Intervention Results: - The post-intervention group demonstrated a substantial increase in HPV vaccine rates, from 17.8% to 63.6% ,[object Object],.

Conclusion: - The study concluded that strategically implementing standardized clinical vaccine policies and presumptive provider communication practices has implications for significantly increasing HPV vaccine uptake among teens and may be key to preventing cancer among future generations ,[object Object],.

Study Design: - The study utilized a pre/post design to compare vaccine rates, and data was obtained via electronic health records ,[object Object],.

Setting: - The project was completed at a private pediatric practice in a suburban location in New England ,[object Object],.

Population of Focus: - The target audience consisted of 11- and 12-year-old adolescents who had not previously been vaccinated for HPV ,[object Object],.

Sample Size: - The project included 128 patients, with 73 patients in the pre-intervention group and 55 in the post-intervention group. Most patients were 12 years old in both groups ,[object Object],.

Age Range: - The project included 128 patients, with 73 patients in the pre-intervention group and 55 in the post-intervention group. Most patients were 12 years old in both groups ,[object Object],.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, PATIENT_CONSUMER

Intervention Description: To determine the effectiveness of patient portal outreach messages, with and without the date of the last WCC, on the scheduling and completion of WCC visits and completion of vaccinations.

Intervention Results: Nine hundred forty-five patients participated (mean [SD] age, 9.9 [3.3] years, 493 [52.2%] girls, 590 [62.4%] non-Hispanic Black, 807 [85.4%] publicly insured). Scheduling rates were 18.4% in the standard message group (adjusted risk ratio [aRR], 1.97; 95% CI, 1.32-2.84) and 14.9% in the tailored message group (aRR, 1.57; 95% CI, 1.02-2.34) compared with the control group (9.5%). Well child care visit completion rates were 24.1% in the standard message group (aRR, 1.92; 95% CI, 1.38-2.60) and 19.4% in the tailored message group (aRR, 1.52; 95% CI, 1.06-2.13) compared with the control group (12.7%). Among eligible children, rates of receiving the COVID-19 vaccine were 16.7% in the standard message group compared with 4.8% in the tailored message (aRR, 3.41; 95% CI, 1.14-9.58) and 3.7% in the control groups (aRR, 4.84; 95% CI, 1.44-15.12).

Conclusion: In this randomized clinical trial, outreach messages delivered via electronic health record patient portals increased the rates of scheduling and completing WCC visits and receiving the COVID-19 vaccine, providing a useful tool to help restore WCC in populations whose care was delayed during the pandemic.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation,

Intervention Description: Mail reminders for vaccination appointments

Intervention Results: Telephone survey based on medical record-generated list for those who would fit study criteria, are asked about recall for mail reminders, then assessment is done on recall in tandem with who was vaccinated

Conclusion: Mail out reminders were successful and viable for pediatric patients with hematologic conditions with parents having similar or increased interest in vaccinations after the mailer compared to those who didn't recall the mailer.

Study Design: retrospective cohort design

Setting: Edmonton, Alberta Stollery Children's Hospital

Population of Focus: Pediatric Hematology Oncology providers

Sample Size: 249 determined eligible, with 179 completing survey

Age Range: None specified, but must meet age criteria to be in pediatric hematology oncology dept.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, PATIENT_CONSUMER

Intervention Description: To determine effectiveness of text/telephone outreach messages, with and without coronavirus disease 2019 (COVID-19) vaccine information. Study design

Intervention Results: We randomized 1235 adolescents (mean age, 14 ± 1.5 years; 51.6% male; 76.7% Black; 4.1% Hispanic/Latinx; 88.3% publicly insured). The standard message group had higher odds of scheduling an adolescent well-care visit compared with the control group (OR, 2.07; 95% CI, 1.21-3.52) and COVID-19 vaccine message group (OR, 1.66; 95% CI, 1.00-2.74). The odds of completing an adolescent well-care visit did not differ significantly (standard message group vs control group; OR, 1.35; 95% CI, 0.88-2.06; COVID-19 vaccine message group vs control group, OR, 1.33; 95% CI, 0.87-2.03). In per-protocol analyses, adolescents in the standard message group were twice as likely as the control group to receive the COVID-19 vaccine (OR, 2.48; 95% CI, 1.05-5.86).

Conclusion: Outreach messages were minimally effective. Efforts are needed to address widening disparities.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, PROVIDER/PRACTICE, Provider Audit/Practice Audit, Nurse/Nurse Practitioner

Intervention Description: To assess the effects on cervical screening rates in one small general practice based on uptake and the benefits of multiple strategies.

Intervention Results: Over 18 months there was a 27% improvement from a biannual screening rate of 53% at baseline to 67.5% at the end of the audit. Over the past 6 months, 49% of women elected for the 'screening only' test provided by a nurse.

Conclusion: Strategies are feasible and associated with a considerable increase in screening rates. Patients can choose to have their test performed by a nurse in general practice. This study suggests that each strategy's improvement in uptake is independently additive.

Study Design: QE: pretest-posttest

Setting: General practice in Bundaberg, Queensland

Population of Focus: Women attending the practice living within Bundaberg

Data Source: Chart review

Sample Size: Baseline (n=1,540) Follow-up (n=1,431)

Age Range: 18-69

Intervention Components (click on component to see a list of all articles that use that intervention): Other Education, Provider Training/Education, Development/Improvement of Services, Patient Reminder/Invitation

Intervention Description: This intervention presents a toolkit developed by the March of Dimes, California Maternal Quality Care Collaborative, and the California Department of Public Health, aimed at eliminating non-medically indicated (elective) deliveries before 39 weeks of gestation. The toolkit provides guidance and strategies for healthcare providers, hospitals, and policymakers to reduce early elective deliveries (EEDs), which are associated with neonatal morbidities and increased healthcare costs. It identifies common barriers to reducing EEDs, such as lack of effective policies, provider resistance, lack of patient awareness, and data collection challenges. The toolkit offers recommendations to overcome these barriers through policy changes, hard-stop policies, provider and patient education, data collection guidance, and measurement strategies using The Joint Commission's PC-01 measure for EEDs.

Intervention Results: The toolkit highlights several successful quality improvement (QI) interventions implemented by healthcare organizations to reduce early elective deliveries. Intermountain Healthcare, through a multidisciplinary team approach, data-driven interventions, and strict enforcement of policies, reduced elective deliveries before 39 weeks from 28% to less than 3% within six years. Additionally, they observed a decrease in stillbirth rates and no significant increase in maternal morbidity. Magee Women's Hospital achieved a significant reduction in elective inductions before 39 weeks and lower cesarean section rates among nulliparous women after implementing induction guidelines, involving key physician and nursing leaders, and establishing a chain of support for enforcement. The Ohio Perinatal Quality Collaborative reported a decrease in elective deliveries from 25% to less than 5% within 14 months among participating hospitals, along with a decline in stillbirth rates and fewer NICU admissions for infants born between 36 and 38 weeks.

Conclusion: Despite efforts to curb early elective deliveries, the toolkit acknowledges that some areas still face difficulties in achieving desired results. It emphasizes the need for a coordinated effort from various stakeholders, including healthcare providers, hospitals, professional organizations, patient advocates, and policymakers. The toolkit serves as a comprehensive resource, offering evidence-based strategies, educational tools, and case studies to support the elimination of non-medically indicated deliveries before 39 weeks. By addressing barriers, promoting policy changes, enhancing data collection and measurement, and increasing awareness among providers and patients, the toolkit aims to facilitate sustainable improvements in maternal and neonatal health outcomes.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Administration/Practice Management, Quality Improvement, HOSPITAL, PATIENT_CONSUMER, Patient Reminder/Invitation, HEALTH_CARE_PROVIDER_PRACTICE, EMR Reminder

Intervention Description: Researchers implemented process changes in 3 phases: phase 1, changing the screening instrument and adding decision support; phase 2, adding automatic reminders; and phase 3, adding a referral option for autism evaluations in primary care. We analyzed the proportion of visits with autism screening at 2 intervention clinics before and after implementation of process changes versus 27 community clinics (which received only automatic reminders in phase 2) with χ2 test and interrupted time series.

Intervention Results: In 12 233 visits over 2 years (baseline and phased improvements), autism screening increased by 52% in intervention clinics (58.6%-88.8%; P < .001) and 21% in community clinics (43.4%-52.4%; P < .001). In phase 1, interrupted time series trend for screening in intervention clinics increased by 2% per week (95% confidence interval [CI]: 1.1% to 2.9%) and did not increase in community clinics. In phase 2, screening in the community clinics increased by 0.46% per week (95% CI: 0.03% to 0.89%). In phase 3, the intervention clinic providers referred patients for diagnostic evaluation 3.4 times more frequently (95% CI: 2.0 to 5.8) than at baseline.

Conclusion: We improved autism screening and referrals by changing the screening instrument, adding decision support, using automatic reminders, and offering autism evaluation in primary care in intervention clinics. Automatic reminders alone improved screening in community clinics.

Setting: Pediatric and community clinics

Population of Focus: Pediatricians and staff

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, CAREGIVER, Educational Material (caregiver)

Intervention Description: The aim of this study was to evaluate the effectiveness of a nursing educational intervention with mothers of sick children to decrease passive smoking exposure.

Intervention Results: Baseline comparison showed no significant differences between the two groups in the mothers’ actions to protect the children from passive smoking exposure. More mothers in the intervention group than the control group had always moved the children away when they were exposed to the fathers’ smoke at home at 3‐month follow up (78·4% vs. 71·1%; P = 0·01) but became non‐significant at 6 and 12 months.

Conclusion: A simple health education intervention provided by nurses to the mothers in a busy clinical setting can be effective in the short-term to motivate the mothers to take actions to protect the children from exposure to passive smoking produced by the fathers.

Study Design: RCT

Setting: Hospital (pediatric ward/outpatient departments)

Population of Focus: Non-smoking mothers of sick children admitted to the pediatric ward/smoking husbands living in the same household

Data Source: Parental self-report.

Sample Size: 1483 mothers of sick children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, Educational Material,

Intervention Description: The intervention strategies include tailored HPV vaccination reminder postcards for parents, clinic-wide HPV vaccination trainings, quarterly review of HPV vaccination data, a physician champion, and clinic visual cues such as examination room posters, educational handouts, lanyards, and pins

Intervention Results: The primary outcomes of analyses were HPV vaccine initiation and completion rates

Conclusion: there was an increase in HPV vaccine uptake among adolescent patients ages 11–17. The proportion of adolescent patients who had initiated the HPV vaccine series was significantly greater at follow-up compared to baseline, with an increase from 52.4% to 82.7%. Similarly, the proportion of adolescent patients who had completed the HPV vaccine series was also significantly greater at follow-up compared to baseline, with an increase from 27.0% to 58.0%

Study Design: The study is described as a pilot study with a multilevel (ML) intervention design

Setting: The setting of the study is a rural health clinic in the United States, with a focus on Native American and rural communities

Population of Focus: The target audience includes parents, caregivers, and adolescent patients ages 11–17

Sample Size: The sample size is not explicitly mentioned in the provided excerpt.

Age Range: The study focuses on adolescent patients ages 11–17

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation

Intervention Description: To assess the effect of an invitation letter on the level of participation in a setting of mainly opportunistic screening for cervical cancer and to do a cost analysis of this intervention.

Intervention Results: 3% greater increase in number of women who received a Pap smear in intervention group than control group (95% CI: 2.6-3.4)

Conclusion: Within an opportunistic cervical cancer screening setting, the effect of a registry-based invitational programme to nonattenders increases the participation further, and at no extra cost compared with an invitational programme to all screen-eligible women irrespective of their screening status.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Limburg

Population of Focus: Women in the Limburg Cancer Registry who had no Pap smear reported in the past 30 months

Data Source: Limburg Cancer Registry

Sample Size: Intervention (n=43,523); Control (n=44,131) Intervention Group A (women 25-41) (n=17,224)

Age Range: 25-54

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Designated Clinic/Extended Hours

Intervention Description: Evaluate the effectiveness of an invitation letter on cervical screening participation among unscreened women 30 to 69 years of age.

Intervention Results: Women who were sent an invitation letter were significantly more likely to have had a Pap test in the next 6 months compared with women who were not sent an invitation letter (odds ratio [OR]=2.60, 95% confidence interval [CI] 2.09-3.35, p<0.001).

Conclusion: Sending invitation letters increased cervical screening participation but because the overall effect was small, additional strategies that remove barriers to screening for unscreened women are also necessary.

Study Design: Cluster RCT

Setting: Manitoba

Population of Focus: Women who had no Pap smear reported since 2001 and had been registered in the screening registry for at least 5 years (as of June 2010), with no history of gynecological cancer or hysterectomy, and who were covered by provincial health care insurance

Data Source: Cervical cancer screening registry

Sample Size: Total (N=31,452) Intervention (n=17,068); Control (n=14,384)

Age Range: 30-69

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Quality Improvement/Practice-Wide Intervention, Designated Clinic/Extended Hours, Female Provider, Needs Assessment, PATIENT_CONSUMER, HOSPITAL

Intervention Description: Translational research (TR) and continuous quality improvement (CQI) processes used to identify and address barriers and facilitators to Pap smear screening within an urban Aboriginal Community Controlled Health Service (ACCHS).

Intervention Results: There was a statistically significant increase in Pap smear numbers during Plan-Do-Study-Act (PDSA) cycles, continuing at 10 months follow up.

Conclusion: he use of TR with CQI appears to be an effective and acceptable way to affect Pap smear screening. This model is transferrable to other settings and other health issues.

Study Design: QE: pretest-posttest

Setting: An urban Aboriginal Community Controlled Health Service (ACCHS)

Population of Focus: All women within eligible age range

Data Source: Electronic medical records

Sample Size: Total (N=213)

Age Range: 18-70

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation

Intervention Description: A randomized (1:1) controlled trial was conducted among 13 Portuguese primary care units, recruiting women aged 25 to 49 years, eligible for cervical cancer screening, with an available mobile phone number. In the intervention group, participants were invited for cervical cancer screening through automated/customized text messages and phone calls, followed by text message reminders. Participants in the control group were invited through a written letter (standard of care). The primary outcome was the proportion of women adherent to screening up to 45 days after invitation and the secondary outcome was defined as the adherence proportion after invitation based only on text messages and reminders.

Intervention Results: A total of 1220 women were randomized, 605 to intervention and 615 to control group. The adherence to cervical cancer was significantly higher among women assigned to intervention (39.0% vs. 25.7%, p < 0.001); this corresponds to a difference of 13.3% (95% CI 8.1 to 18.5). The difference in adherence between an invitation strategy based only on text messages and reminders and the standard of care was −0.4%, 95% CI −5.3 to 4.5.

Conclusion: In conclusion, an invitation to cervical cancer screening using automated text messages/phone calls and reminders increases the adherence to cervical cancer screening. Such a low-cost and operator-independent strategy of invitation may contribute to the sustainability of organized screening programs.

Setting: Primary care settings in Portugal

Population of Focus: Women ages 25-49

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation

Intervention Description: The aim of this study was to test the effectiveness of a stepwise intervention with an increasing level of complexity and cost to increase adherence to organized cervical cancer screening. This was a randomized (1: 1) controlled trial, conducted among 13 Portuguese primary health care units. Participants (n = 1220) were women aged 25–49 years, eligible for cervical cancer screening, with a mobile phone number available. The tested intervention was a 3-step invitation to screening, based on automated text messages/phone calls (step 1), manual phone calls (step 2) and face-to-face interviews (step 3), applied sequentially to non-adherent women after each step. Participants in the control group were invited through a written letter (standard of care). The primary outcome was the proportion of women screened, which was assessed after step 1 (45 days after the initial invitation), steps 1 + 2 (90 days after the initial invitation) and steps 1 + 2 + 3 (150 days after the initial invitation).

Intervention Results: Adherence to cervical cancer screening was significantly higher among women assigned to the intervention than those in the control group for step 1 (39.9% vs. 25.7%, p < 0.001), steps 1 + 2 (48.6% vs. 30.7%, p < 0.001) and steps 1 + 2 + 3 (51.2% vs. 34.0%, p < 0.001).

Conclusion: In conclusion, adherence to cervical cancer screening was higher by 17% among women invited through the 3-step intervention, compared to those receiving the standard invitation letter. The former strategy has the potential to be broadly implemented due to the low requirements of technology and training.

Setting: Portuguese National Healh Care system, primary care screening

Population of Focus: Portuguese women ages 25–49 years, eligible for cervical cancer screening, with a mobile phone number available.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Telephone Support

Intervention Description: To evaluate the impact of text messaging on smoking cessation rates among pregnant women in addition to standard of care (SOC) smoking cessation services. Our SOC includes pharmacist-driven education with or without nicotine patch or bupropion.

Intervention Results: Of 49 randomized patients, 13 withdrew, and 6 were lost to follow-up. The remaining included 14 texting and 16 SOC patients. eCO-verified cessation was achieved by 57.1% in the texting group versus 31.3% in the control (P = 0.153). Overall, 64.3% of the texting group achieved an eCO below 8 ppm at ≥1 visit versus 37.5% in the control group (P = 0.143). No difference was found in birth outcomes. The study was underpowered because of slow enrollment and high drop-out rates.

Conclusion: Text messaging had minimal impact on improving smoking cessation rates in the obstetric population. However, further research is warranted because of the underpowered nature of this trial. Given the detrimental effects of smoking in pregnancy, more comprehensive cessation strategies are warranted.

Study Design: RCT- pilot

Setting: Maternal fetal care center

Population of Focus: English-speaking pregnant women at least 18 years old receiving care at the maternal fetal care center and were willing to set a smoking *quit* date prior to 35 weeks gestation.

Data Source: Self-report, exhaled carbon monoxide levels (eCO)

Sample Size: 49

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation

Intervention Description: An intervention was conducted from June 2015 to September 2015, in which reminders to schedule a Pap smear were sent to the remaining cohort of 473 women via sequential text messaging, followed by phone call attempts.

Intervention Results: Of all subjects, 94% contacted by text messages and 41% contacted by phone calls were successfully reached. There was an increase in the rate of completed Pap smears from 2.5% (12/485) at baseline to 11.8% (56/473) after interventions (p < 0.0001) in a period of three months. Out of the 68 Pap smear results, 20 (29.4%) were abnormal.

Conclusion: Our intervention, utilizing methods of communication such as text messaging and phone calls, markedly increased the rate of completed Pap smear screening in our population.

Setting: HIV Wellness Center, an outpatient center affiliated with University Medical Center (UMC) of Southern Nevada.

Population of Focus: HIV-infected women 18 and older who had no documented Pap result in the past year

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling, Motivational Interviewing, Patient Reminder/Invitation, PROVIDER/PRACTICE, Nurse/Nurse Practitioner

Intervention Description: To determine if mothers receiving a smoking cessation intervention emphasizing health risks of environmental tobacco smoke (ETS) for their children have a higher quit rate than 1) mothers receiving routine smoking cessation advice or 2) a control group.

Intervention Results: Complete data (baseline and both follow-ups) were available for 166 subjects. There was no impact of group assignment on the quit rate, cigarettes/day, or stage of change. The Child Health Group intervention had a sustained effect on location where smoking reportedly occurred (usually outside) and on improved knowledge of ETS effects.

Conclusion: Further research is needed to devise more effective methods of using the pediatric health care setting to influence adult smoking behaviors.

Study Design: RCT

Setting: Primary care center in a large urban children’s hospital

Population of Focus: Female caregivers (16 years and older) who accompanied a child (under 12 years) to the Primary Care Center of Columbus Children’s Hospital for a health care visit for any chief complaint or well-child examination

Data Source: Baseline data on demographics and smoking topics collected by questionnaire; and 1- and 6-month follow-ups.

Sample Size: 479 mothers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Patient Reminder/Invitation, Text Messaging,

Intervention Description: As part of an ongoing quality improvement project, the hospital implemented a remote hypertension monitoring protocol for postpartum women with a diagnosis of chronic hypertension, superimposed preeclampsia, gestational hypertension, preeclampsia, or postpartum hypertension. After identification by an obstetric care provider, women with access to a text messaging-enabled smartphone device are enrolled in the 6-week postpartum program, which is automatically indicated in the electronic medical record. Participants are trained on the use of a blood pressure device (obtained through insurance, patient purchase or hospital provision) by a nurse educator before discharge from the hospital. After discharge, participants are prompted to check their blood pressure 5 days per week and are prescribed an antihypertensive medication from a call center physician if clinically indicated. Women with blood pressures exceeding the goal who are asymptomatic are encouraged to keep their postpartum office visit.

Intervention Results: Among women enrolled in the program, 360 (88%) attended a 6-week postpartum visit, compared with a historical background rate of 60% attendance among all deliveries and 66% attendance among women with a hypertensive disorder of pregnancy in the year before implementation of the program (2017). Compliance with the program was high. Based on the protocol, 177 (43%) women did not require the previously scheduled in-office blood pressure check at 1-week postpartum, the majority (112; 63%) were in the no medication group. Of the 232 women who required a blood pressure check based on the protocol, 198 (85%) women attended the visit. Of the 409 women who have completed the program to date, 340 (83%) continued the program beyond 3 weeks postpartum and 302 (74%) continued the program beyond 4 weeks postpartum. An ongoing goal of the program is to bridge care from obstetricians to primary care physicians; currently 87 (21%) participants have established care with a primary care physician postpartum, with an additional 42% reporting that they have scheduled an appointment with their primary care physician.

Conclusion: In this study, we detail results from an ongoing remote blood pressure monitoring program. We demonstrate high compliance, retention, and patient satisfaction with the program. This is a feasible, scalable remote monitoring program connected to the electronic medical record.

Study Design: Quality improvement project

Setting: University of Pittsburgh medical center

Population of Focus: At risk postpartum women

Sample Size: 499

Age Range: Childbearing age

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation, Incentives, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Residents/Medical Students

Intervention Description: Phase 1 lasted 9 months and implemented CCS patient outreach, patient financial incentives, and clinic staff education. Phase 2 lasted 9 months and involved a workflow change in which MAs identified candidates for CCS during patient check-in. Feedback spanned the entire study period.

Intervention Results: After interventions, the average number of monthly Pap tests increased from 35 to 56 in phase 1 and to 75 in phase 2. Of 385 patients contacted in phase 1, 283 scheduled a Pap test and 115 (41%) completed it. Compared to baseline, both interventions improved cervical cancer screening (phase 1 relative risk, 1.86; 95% CI, 1.64–2.10; P < 0.001; phase 2 relative risk, 2.70; 95% CI, 2.40–3.02; P < 0.001). Our clinic’s CCS rate improved from 70% to 75% after the 18-month intervention.

Conclusion: The rate of CCS increased by 5% after a systematic 2-phase organizational intervention that empowered MAs to remind, identify, and prepare candidates during check-in for CCS.

Setting: Urban academic internal medicine clinic

Population of Focus: Women ages 21-64 eligible for cervical cancer screening

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Patient Reminder/Invitation, Text Messaging,

Intervention Description: The intervention involved a text-based surveillance arm, where women were given an automatic Omron blood pressure cuff and instructed on its use. Patients were enrolled into a texting program platform developed through Way to Health, a web-based platform within the institution, with secure technological infrastructure developed for research. Patients received reminders to text message their blood pressures twice daily for 2 weeks postpartum, and immediate feedback was provided to the patient based on a preprogrammed automated algorithm. The primary investigator was alerted with specified severe range blood pressure values via text message or email, and care was escalated as needed based on the outpatient algorithm used in the office

Intervention Results: The study found that text-based monitoring was more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate post-discharge period in women with pregnancy-related hypertension compared with traditional office-based follow-up.

Conclusion: Text-based monitoring is more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate postdischarge period in women with pregnancy-related hypertension compared with traditional office-based follow-up.

Study Design: Randomized control trial

Setting: Two prenatal practices within a single medical sytem

Population of Focus: Health care providers; postpartum patients with pregnancy-related hypertenion

Sample Size: 206 women with pregnancy-related hypertension

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Provider/Patient Communication Portal, Patient Reminder/Invitation,

Intervention Description: The intervention was a reminder system that sent portal reminders to patients according to randomization arm at the beginning of October (all intervention groups), November (those receiving 2-3 reminders), and December (those receiving 3 reminders).

Intervention Results: The study found that the reminder system significantly increased influenza vaccination rates among patients in the intervention groups compared to the control group.

Conclusion: The study concluded that a reminder system can be an effective tool for increasing influenza vaccination rates among patients.

Study Design: The study design was a 4-arm, pragmatic, intention-to-treat randomized clinical trial.

Setting: The study was conducted within all 52 UCLA Health System primary care practices.

Population of Focus: Patients within UCLA Health System practices who were 6 months or older at intervention launch and were defined as influenza vaccination eligible.

Sample Size: A total of 164,205 patients were randomly allocated to 1 of the 4 study arms

Age Range: Patients who were 6 months or older at intervention launch were included in the study.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation

Intervention Description: A targeted invitation to women not participating for the last 5 years in cervical screening was evaluated to determine whether it would decrease the number of these women. Increasing general practitioners' attention to the screening programme for cervical cancer was also evaluated to determine whether it would increase participation.

Intervention Results: The decline in non-attenders was 0.87% (95% CI 0.57% to 1.16%) after 9 months in favour of the intervention. A difference of 0.94% (95% CI 0.21% to 1.67%) in the change of coverage rate was observed at 6 months, which increased to 1.97% (95% CI 0.03% to 3.91%) at 9 months in favour of the intervention.

Conclusion: It is possible to decrease the proportion of non-attenders and increase the coverage rate in a screening programme for cervical cancer using a special targeted invitation to non-attenders combined with a visit to GPs.

Study Design: Cluster RCT

Setting: General practices (GPs) in the county of Aarhus

Population of Focus: Women who had not had a Pap smear in the last 5 years GPs in Aarhus

Data Source: Database that included women’s Pap smear information, regardless of where she had received the screening

Sample Size: Total (N=117,129) Intervention (n=57,946); Control (n=59,183)

Age Range: 23-59

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation

Intervention Description: This randomized controlled trial examined whether a personalized form (PF) letter containing generic cancer information and a personalized tailored (PT) letter containing minimally tailored individualized risk factor information based on medical records data affected breast and cervical cancer screening among 1574 urban low-income and minority women.

Intervention Results: The personalized form-letter group was significantly more likely to schedule a screening appointment and to have undergone a Pap test and mammography within 1 year after the intervention than were the tailored letter and control groups (P<0.001 for all comparisons).

Conclusion: Personalized tailored letters that contain individualized cancer risk factor information may decrease the likelihood of receiving cancer screening among medically underserved low-income and minority women, but personalized form letters that contain generic cancer information may improve these rates in this disadvantaged population.

Study Design: RCT

Setting: Two urban community health centers in Houston, TX

Population of Focus: African American, Mexican American, and non-Hispanic white women who were registered at participating health centers

Data Source: Database provided by woman’s primary care provider

Sample Size: Total (N=1,574) Analysis (n=1,483) Intervention Group 1 (n=524); Intervention Group 2 (n=460); Control (n=499)

Age Range: 18-64

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation

Intervention Description: The 1,574 women participating in the randomized controlled trial were assigned to one of three groups: (1) PF letter, (2) PT letter, (3) control (no letter).

Intervention Results: Logistic regression analyses show that (1) personalized-tailored letters containing individualized references to recipients' cancer risk factors failed to increase rates of recommended cancer screening behaviors, especially among non-Hispanic white women; and that (2) in contrast, a personalized-form letter with general breast and cervical cancer screening messages increased cancer screening rates in this population, especially among non-Hispanic white and Mexican-American women

Conclusion: Recent reports suggesting that cancer death rates in women have stabilized since 2000 after a number of years of decline, alongside reported ongoing declines in cancer death rates for men,38 suggest that aggressive and effective efforts to control cancer risk in women are still needed. TPC focusing on individual factors important in behavioral change has been a strategy used to improve the relevancy of a message for a specific person. From a practice perspective, the findings of the present study suggest that physicians and others involved in cancer screening services may want to be cautious about including risk-related information gleaned from medical records in prompting messages sent to patients for the purposes of promoting compliance with screening recommendations

Study Design: RCT

Setting: Two urban community health centers in Houston, TX

Population of Focus: African American, Mexican American, and non-Hispanic white women who were registered at participating health centers

Data Source: Database provided by woman’s primary care provider

Sample Size: Total (N=1,574) Analysis (n=1,483) Intervention Group 1 (n=524); Intervention Group 2 (n=460); Control (n=499)

Age Range: 18-65

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation

Intervention Description: Letters were sent to 15,691 unscreened and 6,995 under-screened women from Cape Breton Island encouraging them to obtain a Pap test. Controls were 61,510 unscreened women and 32,996 under- screened women in mainland Nova Scotia who were not sent letters.

Intervention Results: For this cohort study, the provincial Health Card Number database and Provincial Cytology Registry were linked. Having a Pap smear was associated with having received a letter (OR = 1.64), having been previously under-screened rather than unscreened (OR = 1.85), with youth and with higher income (OR = 1.13). After receiving a letter, women in Aboriginal, Mixed Black, Acadian, and rural communities had smear rates similar to those of other women.

Conclusion: Being previously unscreened, rather than under-screened, was associated with higher rates of abnormalities (OR = 1.62), indicating greater need for early detection and treatment to prevent invasive cancer. While one-time letters to women improved the Pap smear screening rates, multiple, continuous interventions are needed to make a more substantive improvement in these rates.

Study Design: RCT

Setting: Cape Breton Island and Mainland Nova Scotia

Population of Focus: Women who were either unscreened (no Pap smear recorded from January 1988- letter mailing date) or underscreened (at least one Pap smear recorded between January 1988- January 1995 but none recorded from January 1995-letter mailing date)

Data Source: Provincial Cytology Registry

Sample Size: Total (N=360,587) Analysis (n=113,426) Intervention (n=21,601); Control (n=91,825) Additional control group (n=1,218)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Financial Incentives, Nurse/Nurse Practitioner

Intervention Description: Before-and-after comparisons of the time-appropriate delivery rates of cervical and breast cancer screening using the automated and NP-augmented strategies of the P-PROMPT reminder and recall system.

Intervention Results: Before-and-after comparisons of time-appropriate delivery rates (< 30 months) of cancer screening showed the rates of Pap tests and mammograms for eligible women significantly increased over a 1-year period by 6.3% (P < .001) and 5.3% (P < .001), respectively. The NP-augmented strategy achieved comparable rate increases to the automated strategy alone in the delivery rates of both services.

Conclusion: The use of provider and patient reminders and pay-for-performance incentives resulted in increases in the uptake of Pap tests and mammograms among eligible primary care patients over a 1-year period in family practices in Ontario.

Setting: Eight primary care network practices and 16 family health network practices in southwestern Ontario

Population of Focus: Practicing physicians from the participating primary care network and family health network groups

Data Source: CytoBase (consortium of main laboratories in Ontario), combined with rosters of eligible patients

Sample Size: Total (N=246) Analysis (n=232) N=physicians

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, PATIENT_CONSUMER

Intervention Description: We examined whether mailing unsolicited human papillomavirus (HPV) self-sampling kits to increase cervical cancer screening impacted receipt of other preventive services women were due for: mammography, colorectal cancer (CRC) screening, influenza vaccination, depression screening, and diabetic HbA1c monitoring. From 2014 to 2016, 16,590 underscreened women were randomized to receive a mailed kit or usual care Pap reminders within Kaiser Permanente Washington. We used logistic regression to estimate odds ratios (ORs) of preventive services receipt within 12-months between the intervention vs. control arms, and within the intervention arm (comparing those returning a kit vs. attending Pap vs. nothing), adjusting models for demographic variables.

Intervention Results: There were no significant between-arm differences in uptake of any of the preventive services: intervention vs. control: mammography OR = 1.01 (95% confidence interval:0.88–1.17), CRC screening OR = 0.98 (0.86–1.13), influenza vaccination OR = 0.99 (0.92–1.06), depression screening OR = 1.07 (0.99–1.16), HbA1c OR = 0.84 (0.62–1.13). Within the intervention arm, preventive services uptake was higher in women who completed cervical cancer screening vs. did not, with stronger effects for women who attended Pap: Pap vs. nothing: mammography OR = 11.81 (8.11–17.19), CRC screening OR = 7.31 (5.57–9.58), influenza vaccination OR = 2.06 (1.82–2.32), depression screening OR = 1.79 (1.57–2.05), HbA1c OR = 3.35 (1.49–7.52); kit vs. nothing: mammography OR = 2.26 (1.56–3.26), CRC screening OR = 5.05 (3.57–7.14), influenza vaccination OR = 1.67 (1.41–1.98), depression screening OR = 1.09 (0.89–1.33), HbA1c OR = 1.23 (0.57–2.65). Mailing HPV self-sampling kits to underscreened women did not negatively impact uptake of other preventive services. However, overall preventive service uptake was the highest among women who attended in-clinic cervical cancer screening.

Conclusion: Individuals who are overdue for cervical cancer screening remain a hard-to-reach population, even after removing barriers associated with in-person screening. While cervical cancer screening rates remained low,(Winer et al., 2019) mailing HPV kits improved cervical cancer screening rates and did not result in reduced uptake of other recommended preventive services.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation, Provider/Patient Communication Portal, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: Secondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed. For each cancer screening, inclusion criteria were based on the age of screening recommendations and prior history of cancer diagnosis (n=35,912 for breast, n=48,512 for cervical, and n=45,884 for colon). The independent variable was whether adults used email PPC in the past 12 months (yes or no). The dependent variables were whether (1) women (aged ≥40 years) received a mammogram in the past 12 months; (2) women (aged 21-65 years) received a Pap test in the past 12 months; and (3) individuals (aged ≥50 years) received a colon cancer screening in the past 12 months. Bivariate and multivariable logistic regression analyses were conducted.

Intervention Results: Adults who reported receiving all three cancer screenings in the past 12 months were more likely to be non-Hispanic White; be married or living with a partner; have a bachelor’s degree or higher education level; have health insurance coverage; and perceive their health as excellent, very good, or good (all P<.001). Men were more likely to receive colon cancer screenings than women (P<.001). Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast (odds ratio [OR] 1.32, 95% CI 1.20-1.44) and cervical (OR 1.11, 95% CI 1.02-1.20) cancer screenings than women who did not use email PPC. Adults who used email to communicate with their health care providers had 1.55 times greater odds (95% CI 1.42-1.69) of receiving a colon cancer screening than those who did not use email PPC.

Conclusion: Our results demonstrate that email PPC is a marker of increased likelihood of adults completing age-appropriate cancer screenings, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of email PPC between patients and health care providers and determine avenues for health education and intervention to further explore this association.

Setting: Primary care setting

Population of Focus: Women ages 21-64 who received primary care within the past 12 months

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation

Intervention Description: We conducted a pragmatic randomized trial comparing outreach by mailed letter or personalized phone call for patients overdue for cervical, breast, or colorectal cancer screening. The study was conducted at 6 clinics within an academic primary care organization in Toronto, Canada. Our primary outcome was an uptake of at least 1 screening test for which the patient was overdue. Our primary analysis was an intention-to-treat, unadjusted comparison of proportions, using a χ2 test. We also compared costs per additional patient screened. All analyses were stratified by sex.

Intervention Results: A total of 3733 females and 1537 males were randomized to receive 1 of the interventions. Among women, 33.0% allocated to receive a reminder letter and 41.2% allocated to receive a reminder phone call received at least 1 screening test for which they were due (absolute difference, 8.1%; 95% CI, 5.1%–11.2%, P < .001). Among men, 24.8% allocated to receive a reminder letter and 28.8% allocated to a reminder phone call received screening for colorectal cancer (absolute difference, 4.1%; 95% CI, −0.4% to 8.5%, P = .073). For women and men, the letters cost approximately CaD $5.07 and CaD $7.16, respectively, for each completed screening test compared with CaD $8.71 and CaD $12.00 for the phone calls.

Conclusion: Phone calls were more effective than mailed letters at increasing uptake for cervical, breast, and colorectal cancer screening among women. However, phone calls were more expensive than letters. Primary care practices should consider integrating phone call reminders into their practice, possibly as part of a targeted or staged approach to outreach for cancer screening.

Setting: Academic primary care

Population of Focus: Women 21+ eligible to receive cervical cancer and other preventive screening

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Patient Reminder/Invitation, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Quality Improvement/Practice-Wide Intervention, Nurse/Nurse Practitioner

Intervention Description: Improving cervical cancer screening rates was identified as a priority in a federally qualified health center when only 40% of eligible women were properly screened in 2016. Forty-five percent of the population the clinic serves is uninsured and 60% are Hispanic. The aim of this quality improvement project was to have 75% of the women 21 to 65 years of age who sought care at this clinic during the 60-day project period receive Pap test eligibility screening, enrollment in a state and federal screening program, and case management. Four rapid plan–do–study–act cycles were used. Tests of change included team engagement, patient engagement, eligibility screening, and case log management. Data were analyzed using run charts to evaluate the impact of interventions on outcomes. The interventions consisted of team meetings, a patient engagement tool, an eligibility screening tool, and case log management.

Intervention Results: Among the women who completed care at the clinic during the 60-day project period, 80% were uninsured and 86% were Hispanic. A total of 87% of women received effective care, which consisted of same-day Well Woman Health Care Program enrollment and a same-day Pap test or an appointment to return for a well-woman visit.

Conclusion: A multicomponent approach led to underserved women receiving equitable access to cervical cancer screening and timely enrollment in a cervical cancer screening program.

Setting: Federally qualified health center (FQHC) in Tucson, Arizona,

Population of Focus: Uninsured and underserved women ages 21-65

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation

Intervention Description: In the context of a new adolescent preventive health program in a family practice setting, we compared attendance rates using two invitation protocols, the protocols differing in their emphasis on adolescent autonomy vs parental responsibility.

Intervention Results: The spontaneous response rate was 21%, the agreement to attend rate was 75%, and the attendance rate was 44%. Attendance rates were higher for the girls compared with the boys (54% vs 35%, P = .08) and for the seventh graders compared with the tenth graders (53% vs 31%, P = .03). The spontaneous response rate was lower among the tenth graders using protocol 2 (8% vs 37.5% with protocol1, P = .04), while the agreement to attend rate and attendance rate did not differ for the two protocols.

Conclusion: Nearly one half of this population of adolescents attended preventive health visits at the family nurse's and physician's initiative. A follow-up telephone call after the initial written invitation resulted in increased participation, while approaching the teenager or parent initially did not make a difference in attendance. This pilot study shows the potential for initiating an adolescent health program in the family practice setting.

Study Design: QE: non-equivalent control group

Setting: Family practice clinic in an urban, mainly lower-middle class, Jewish neighborhood in West Jerusalem

Population of Focus: Teenagers ages 12 to 18 (7th graders and 10th graders) years who live with their parents in the neighborhood (all patients have national health insurance and visits are free of charge)

Data Source: Clinic attendance records

Sample Size: Total (N=106) Protocol 1: (n=47) Protocol 2: (n=59)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation (Assistance), Patient Reminder/Invitation, Participation Incentives, Shortened Appointment Interval

Intervention Description: Women were randomized to receive 3–4 and 6–8 weeks postpartum appointments and were followed for 18 months. Study participants were recruited from the VCUMC in-patient postpartum unit by using Electronic Health Records (EHR) to monitor deliveries. Eligible women were contacted within 48 h of delivery and informed about the study. Women who agreed to participate were asked to sign the informed consent form, which authorized research staff to access participants' EHR to enhance tracking of postpartum visit attendance. Study participants were interviewed in person at baseline (within 48 h of delivery) and at the postpartum visit. Participants were compensated $25 for completing the baseline interviews and $30 for completing the postpartum interviews. Follow-up assessments were administered via telephone at 3, 6, 9, 12, and 18-months post-delivery to evaluate secondary outcomes including contraceptive use, infant feeding practices, pregnancy status, stress and social support, and socio-demographic and medical information. Each of the follow-up assessments lasted approximately 10–15 min, and participants were compensated $10 per follow-up assessment. To reduce loss to follow-up, participants' contact information, as well as contact information for at least three persons who would know the participants' whereabouts and could get messages to them, were collected from the patients. To compensate study subjects for their participation and encourage follow-up assessment compliance, thank you letters along with appointment reminders and additional $10 checks were mailed to each participant monthly. This was especially important for hard-to-track women who did not have working phone numbers and did not return for postpartum visits. Additionally, per study protocol, participants received appointment reminder SMS text messages and/or emails 1 day before their scheduled follow-up phone interviews. If participants could not be reached, up to four attempts were made to contact the participant on different days and times of the day, in an effort to schedule the interviews.

Intervention Results: The overall postpartum visit adherence rate was generally high in the study. However, the adherence rate was observed to be relatively lower in the 3–4 weeks group (71%) compared to the 6–8 weeks group (90%). One reason that may explain this finding is that participants may have been more familiar with the traditional 6–8 weeks postpartum visit and thus, may have had some inertia or difficulty in attending a 3–4 week postpartum visit. A large proportion of women were retained in the study as demonstrated by the high completion rates at the 18-month follow-up interview (Total sample: 87.6%; 3–4 weeks group: 88.0%; 6–8 weeks group: 87.3%). Similarly, high adherence to the protocol-directed postpartum visit schedule was reported in the overall study sample (79.7%), as well as in the 3–4 (70.5%) and 6–8 (90.0%) week postpartum groups.

Conclusion: In this trial, we successfully maintained high completion rates throughout the course of the study. This is important given that the study population included hard-to-track women who typically do not return for postpartum visits [12]. Due to economic challenges, underserved women may not have permanent addresses or phone numbers. By utilizing a participant tracking form, we obtained contact information from at least three persons who generally knew the participants' whereabouts and could contact them. This provided multiple avenues for reaching participants and enhanced retention. Additionally, monthly communication and incentives provided the opportunity to maintain participant engagement.

Study Design: Prospective, open-label randomized control trial

Setting: Virginia Commonwealth University Medical Center

Sample Size: 364 women

Age Range: 18-43

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, EMR Reminder,

Intervention Description: Intervention description: The multidisciplinary team developed weekly targeted rounds to identify eligible patients with outstanding immunizations. Exclusion criteria were established, and the team implemented an in-hospital immunization record review, an email reminder, a weekly multidisciplinary eligibility discussion, and an updated rounding tool to increase and sustain immunization rates in this population of infants with CLD.

Intervention Results: Immunization of eligible patients increased from 44% to 75% and was sustained for the next 6 months. The average number of days from admission to immunization record review decreased from 71 days at baseline to 27 days.

Conclusion: The implementation of (1) an in-hospital immunization record review, (2) an e-mail reminder, (3) a weekly multidisciplinary eligibility discussion, and (4) an updated rounding tool was successful in increasing and sustaining immunization rates in this population of infants with CLD. The multidisciplinary CLD meeting was a novel opportunity to discuss immunization eligibility and safety monitoring.

Study Design: Quality improvement initiative. -

Setting: Neonatal intensive care unit (NICU) at a tertiary care children's hospital in the United States.

Population of Focus: Infants with severe chronic lung disease (CLD) in the NICU.

Sample Size: 60 patients.

Age Range: Not specified, but the study focused on 2-, 4-, and 6-month immunization rates.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation

Intervention Description: Ninety thousand under-screened women were randomised to be mailed a 48-month reminder letter to have a Pap test (n=60,000), or not to be mailed a letter (n=30,000). Differences in Pap test rates were assessed by Kaplan-Meier survival analysis, by chi2 tests of significance between Pap test rates in letter versus no-letter groups, and by proportional hazards regression modelling of predictors of a Pap test with letter versus no-letter as the main study variable. T-tests were conducted on mean time to Pap test to assess whether time to Pap test was significantly different between the intervention and control groups.

Intervention Results: After 90 days following each mail-out, Pap test rates in the letter group were significantly higher than in the non-letter group, by approximately two percentage points. After controlling for potential confounders, the hazard ratio of a Pap test within 90 days of a mail-out in the letter group was 1.5 compared with 1.0 in the no-letter group. Hazard ratios of having a Pap test within 90 days decreased significantly with time since last Pap test (p<0.0001); were significantly higher than 1.0 for most non-metropolitan areas of NSW compared with metropolitan areas; and increased significantly with age (p<0.0001). Pap test hazard ratios were not associated with socio-economic status of area of residence, but the hazard ratio was significantly higher than 1.0 if the reminder letter was sent after the Christmas/New Year break. No significant differences in mean time to Pap test were found between the letter and no-letter groups.

Conclusion: Being sent a reminder letter is associated with higher Pap testing rates in under-screened women.

Study Design: RCT

Setting: New South Wales

Population of Focus: Women who had not had a Pap test in 4 years or more

Data Source: New South Wales Pap Test Register

Sample Size: Total (N=90,247) Intervention (n=60,189); Control (n=30,058) Analysis (n=89,699) Intervention (n=59,780); Control (n=29,919)

Age Range: 20-69

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Home Visits

Intervention Description: Evaluate the efficacy of a lay health advisor (LHA) intervention for improving Pap testing rates, to reduce cervical cancer, among women in need of screening.

Intervention Results: Based on medical record review, more women in the LHA arm had a Pap test by the end of the study compared to those randomized to usual care.

Conclusion: LHA interventions show promise for improving screening behaviors among non-adherent women from underserved populations.

Study Design: RCT

Setting: Fourteen Ohio Appalachian clinics

Population of Focus: Women living in Ohio Appalachia, who were not pregnant, and who were in need of a Pap test based on riskappropriate guidelines

Data Source: Medical record review and self-report

Sample Size: Total (N=286) Analysis Medical Record Review (n=270) Intervention (n=139); Control (n=131) Self-Report (n=233) Intervention (n=115); Control (n=118)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Other Person-to-Person Education

Intervention Description: To examine human papillomavirus (HPV) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students.

Intervention Results: At baseline, 41% intended to undergo HPV vaccination. Participants who were currently sexually active and lacked supplemental health insurance had decreased intent. Perceived parental approval regarding HPV vaccination, perceived vulnerability to HPV infection, and belief in health benefits of HPV vaccine were associated with increased intent. HPV vaccine uptake was low (5.5%) and did not differ by study group. However, baseline intent was significantly associated with HPV vaccine uptake.

Conclusion: Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination.

Study Design: RCT

Setting: University Health Service Gynecology Clinic at the University of Michigan

Population of Focus: Full- or part-time female students visiting the clinic for a routine physical and had not received the first dose of the HPV vaccine series

Data Source: University of Michigan University Health Services medical records; self-report via a mailed survey, telephone interview, or email (if dates of vaccination were unavailable)

Sample Size: Total (n=256)4  Intervention (n=128)  Control (n=128)

Age Range: 18-26

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Patient Reminder/Invitation, PATIENT_CONSUMER

Intervention Description: We hypothesized that an SMS text-delivered scheduled gradual reduction (SGR) program plus support texts would outperform SMS support messages alone.

Intervention Results: Adherence to the SGR was adequate with 70% responding to alert texts to smoke within 60 minutes. Women in both arms quit smoking at the same rate (9%–12%). Women also significantly reduced their smoking from baseline to the end of pregnancy from nine cigarettes to four; we found no arm differences in reduction.

Conclusion: Support text messages alone produced significant quit rates above naturally occurring quitting. SGR did not add significantly to helping women quit or reduce. Sending support messages can reach many women and is low-cost. More obstetric providers might consider having patients who smoke sign up for free texting programs to help them quit. A disseminable texting program helped some pregnant women quit smoking.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Patient Reminder/Invitation, Standing Order

Intervention Description: The intervention included training in giving a strong HPV vaccination recommendation, provider prompts, feedback on missed opportunities, and the optional implementation of standing orders and/or reminder-recall strategies

Intervention Results: The multicomponent intervention led to a reduction in missed opportunities for HPV vaccination in both community practices and continuity clinics, with an overall improvement in HPV vaccination rates

Conclusion: The study concluded that the multicomponent intervention, including training in giving a strong HPV vaccination recommendation, provider prompts, and feedback on missed opportunities, effectively reduced missed opportunities for HPV vaccination in both community practices and continuity clinics

Study Design: The study utilized a quality improvement (QI) intervention approach over a 9-month period, involving a multicomponent intervention to reduce missed opportunities for HPV vaccination

Setting: The study was conducted in 33 community practices and 14 pediatric continuity clinics across multiple states, including Alabama, Maine, New Hampshire, New Jersey, Tennessee, and Vermont

Population of Focus: The target audience included healthcare providers in community practices and pediatric continuity clinics, focusing on adolescents aged 11-17 years

Sample Size: The study involved a total of 47 practices, with 33 community practices and 14 pediatric continuity clinics

Age Range: The study focused on adolescents aged 11-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Telemedicine Systems (Hospital), Patient Reminder/Invitation,

Intervention Description: The project team created four interventions to address gaps and increase attendance to the 6‐week comprehensive postpartum visit: a schedule log, postpartum telehealth check‐in visit, administering the EPDS within 6 weeks postpartum (during the telehealth check‐in visit), and a team engagement plan. Appointments for a telehealth check‐in visit and a comprehensive postpartum visit were scheduled for each postpartum patient and tracked using the log. Schedulers served as a patient navigator and scheduled both appointments. The nurse practitioners, physician, and midwife performed telehealth check‐in visits 1– 3 weeks postpartum. Providers used a four‐item checklist, created by the team, and placed the text in the summary of their notes. The four items included the EPDS, inquiring about breastfeeding and any issues, discussing the importance of postpartum visits, and asking about needs for community resources.

Intervention Results: The number of people who attended comprehensive postpartum visits increased to 56.8% (up from 27% prior to the intervention). The team performed a χ2 test of independence to determine the statistical significance of outcomes when compared with the baseline data. The outcome shows a statistically significant result, χ2(1, N=228) = 18.05, p=.000022. During the project, the balancing measure, team efficiency, improved as measured by anonymous surveys to team members.

Conclusion: Overall, this project proved to be low cost with high value for patients and the medical department. The initiative improved care by increasing attendance at comprehensive postpartum visits, identify- ing concerns early, detecting postpartum depression or anxiety in six patients, and identifying a surgical site infection during check‐in visits. The team's success would be intriguing to most practices that provide obstetrical care, given that the national postpartum return rate is only 60%. Recommendations for spread and sustainability include dedicated postpartum patient navigators, who would handle the schedule log, continuation of a check‐in visit, electronic EPDS, and ongoing staff education. Further study could show the efficacy of this model in other settings. Given the increased postpartum attendance and early identification of complications, the team successfully improved effective care to postpartum families in North Philadelphia.

Study Design: Quality improvement initiative

Setting: Einstein Medical Center, a large academic hospital in North Philadelphia

Population of Focus: Postpartum patients

Sample Size: 147 patients

Age Range: Childbearing age

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, Educational Material, Patient Reminder/Invitation

Intervention Description: This study explores the views of women who received a tailored text messaging cessation intervention (MiQuit) during pregnancy, focusing on acceptability, perceived impact, and suggestions for improvements.

Intervention Results: Three main themes were identified: "impact", "approach," and "optimization." Participants described an immediate, yet often short-lived, impact from the texts that distracted and delayed them from smoking and they perceived that texts focusing on the development of and risk to the baby generated more enduring emotional impacts. Most women found receiving support by text preferable to face-to-face cessation support, with participants citing the greater regularity, convenience, and non-judgmental style as particular advantages. Participants would have preferred a longer support program with increased tailoring, greater customization of text timings and consideration of cutting down as an alternative/precursor to quitting.

Conclusion: Pregnancy-specific cessation support by text message was well received and participants considered the support increased their motivation to stop smoking. The focus on the developing baby, the regularity of contact and the provision of gentle, encouraging messages were highlighted as particularly important elements of the program.

Study Design: Qualitative interview

Setting: Mobile based

Population of Focus: Pregnant women smokers aged 17- 37 who had received the MiQuit text messaging intervention as part of a larger RCT

Data Source: Telephone interviews

Sample Size: 15

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation,

Intervention Description: The intervention involved sending reminders to patients via the health care system's electronic health record patient portal. Patients due for an influenza vaccine were sent a letter via the patient portal reminding them about the importance of influenza vaccination, the safety of the vaccine, and the morbidity associated with influenza. Patients were randomized within primary care practices to one of four study groups: no reminder, one reminder, two reminders, or three reminders ,[object Object],. The content of the portal reminder letter was grounded in the Health Belief Model and principles of health literacy. The secure notification was sent by email or text, based on the patients' standard portal preference, informing them that "a message from your doctor" had been posted on the portal. It's important to note that influenza vaccination was not mentioned in the title of the message, and patients had to log in to the portal to read the letter ,[object Object],. If you have any more questions or need further details, feel free to ask!

Intervention Results: The primary outcome of the study was the receipt of one or more influenza vaccinations as documented in the electronic health record. The study found that the influenza vaccination rates were 37.5% for those receiving no reminders, 38.0% for those receiving one reminder (P = .008 vs no reminder), 38.2% for those receiving two reminders (P = .03 vs no reminder), and 38.2% for those receiving three reminders (P = .02 vs no reminder) ,[object Object],. The study also assessed five secondary outcomes related to receipt of one or more influenza vaccinations in the relevant season. These outcomes included vaccinations in predetermined subgroups (age, sex, race/ethnicity, insurance, and influenza vaccination in prior 2 years), vaccinations that were self-reported by patients or proxies via the portal in response to portal reminders, influenza vaccinations before December 15, 2018, vaccinations among those who opened one or more portal reminders vs those who did not open the reminders, and vaccinations in patients in the upper half vs bottom half of overall portal use ,[object Object],. Overall, the study found that generic patient portal reminders may be slightly effective in increasing influenza vaccination rates, but more intensive or more targeted patient motivational strategies appear to be needed ,[object Object],.

Conclusion: Generic patient portal reminders were effective in minimally increasing influenza vaccination rates, but more intensive or more targeted patient motivational strategies appear to be needed.

Study Design: The study utilized a randomized controlled trial (RCT) design to evaluate the effect of patient reminders sent via the health care system's electronic health record patient portal on influenza vaccination rates ,[object Object],. The RCT design is a robust method for assessing the impact of interventions, as it allows for the comparison of outcomes between different intervention arms and a control group. If you have any more questions or need further details, feel free to ask!

Setting: The setting for the information provided in the PDF file is related to a study conducted in a health system, focusing on patient reminder and recall systems for improving immunization rates ,[object Object],. The study involved a total of 164,205 patients who were randomly allocated to one of the four study arms ,[object Object],. If you need further details about the specific setting or context of the study, please feel free to ask!

Population of Focus: The target audience for the study mentioned in the PDF file is the population of patients within the UCLA (University of California, Los Angeles) health care system. Specifically, the study involved 164,205 patients in 52 primary care practices who had used the patient portal within 12 months ,[object Object],. The study aimed to evaluate the effect of patient reminders sent via the health care system's electronic health record patient portal on influenza vaccination rates within this population. If you need more specific details about the target audience or any other aspect of the study, please let me know!

Sample Size: The study involved a total of 164,205 patients who were randomly allocated to one of the four study arms ,[object Object],. This large sample size allowed for a robust evaluation of the effect of patient reminders sent via the health care system's electronic health record patient portal on influenza vaccination rates. If you have further questions about the sample size or any other aspect of the study, feel free to ask!

Age Range: The study included patients who were at least 6 months of age at the start of the intervention, making them eligible for influenza vaccination ,[object Object],. Therefore, the age range of the patients included in the study spans from at least 6 months and older. If you have any more questions or need further details, feel free to ask!

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation

Intervention Description: To assess the impact of a managed care-based patient reminder/recall system on immunization rates and preventive care visits among low-income adolescents.

Intervention Results: Significantly higher rates of annual preventive care visits in the mailed reminder group vs control group (Hazard ratio=1.2; CI=1.1- 1.3; p<.01 Significantly higher rates of annual preventive care visits in the telephone reminder group vs control group (Hazard ratio=1.1; CI=1.0-1.2; p<.05)

Conclusion: Managed care-based mail or telephone reminder/recall improved adolescent immunizations and preventive visits, with modest costs and modest impact.

Study Design: RCT

Setting: Monroe Plan for Medical Care, a not-for-profit managed care organization in upstate New York

Population of Focus: Adolescents ages 10.5 through 17 years enrolled in Monroe Plan on December 31, 2009, with a primary care provider in a participating practice

Data Source: Managed care organization’s claims files

Sample Size: Total (N=4115) Mailed reminder (n=1396) Telephone reminder (n=1423) Control (n=1296)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Home Visits, Transportation Assistance

Intervention Description: To assess the impact of a tiered patient immunization navigator intervention (immunization tracking, reminder/recall, and outreach) on improving immunization and preventive care visit rates in urban adolescents.

Intervention Results: Significant increase in preventive care visit rates in the intervention group vs control group (p<.01)

Conclusion: A tiered tracking, reminder/recall, and outreach intervention improved immunization and preventive care visit rates in urban adolescents.

Study Design: RCT

Setting: 8 urban primary care practices in Rochester, New York

Population of Focus: Adolescents ages 11-15 enrolled in one of the practices

Data Source: Medical record review

Sample Size: Total (N=7546) Intervention (n=3707) Control (n=3,839)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation

Intervention Description: To measure the effect of telephone-based reminder/recall on immunization and well-child care (WCC) visit rates among adolescents in urban practices.

Intervention Results: No significant increase in adolescent well visit rates

Conclusion: An intensive telephone reminder and recall system was only minimally successful in improving immunization and WCC visit rates among urban adolescents. Lack of success was largely owing to changed or inaccurate telephone numbers.

Study Design: RCT

Setting: 4 urban primary care clinics in Rochester, New York

Population of Focus: Adolescents ages 11-14 with one or more visits at each site

Data Source: Medical record review

Sample Size: Total (N=3006) Intervention (n=1496) Control (n=1510)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation,

Intervention Description: The interventions included monthly portal reminders, direct appointment scheduling, pre-commitment messages, and pre-appointment reminders, all aimed at encouraging influenza vaccination

Intervention Results: The study reported an increase in influenza vaccination rates through the implementation of the behavioral economic strategies, with specific details on the effectiveness of each intervention

Conclusion: The study concluded that the use of behavioral economic strategies, such as portal reminders and direct appointment scheduling, can significantly impact influenza vaccination rates within a health system

Study Design: The study design was a two-arm randomized controlled trial (RCT), with a 2 × 2 × 2 nested factorial design within the treatment arm

Setting: The study was conducted across the entire UCLA Health System, involving 67 primary care internal medicine, medicine-pediatrics, family medicine, and pediatric practices across west Los Angeles

Population of Focus: The target audience comprised patients within the UCLA Health System, including individuals of varying demographics and healthcare needs

Sample Size: The study involved a total sample size of 213,773 patients, with 71,167 in the control group and 142,606 in the reminder groups

Age Range: The age range of the study participants included individuals under 18 years, those between 18 and 64 years, and individuals aged 65 and above

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation

Intervention Description: Explore the impact of invitation and reminder letters on cervical cancer screening participation among eligible Ontario women 30 to 69 years of age.

Intervention Results: At 9-month follow-up, intervention group, including women with invalid addresses, significantly more likely to have Pap test (p<.05)

Conclusion: The invitation and reminder letter strategy increased cervical cancer screening participation.

Study Design: QE: pretest-posttest

Setting: Ontario

Population of Focus: Women who had not had a Pap test in the previous 36 months

Data Source: Cytobase and the Ontario Health Insurance Plan’s Claims History Databases

Sample Size: Total (N=273,534) 2014 (n=135,770); 2013 (n=137,764) Analysis (n=27,269) 2014 (n=16,196)6 ; 2013(n=11,073)

Age Range: 30-69

Intervention Components (click on component to see a list of all articles that use that intervention): Access, Patient Reminder/Invitation, Other Education

Intervention Description: The President’s Cancer Panel. Accelerating HPV Vaccine uptake: Urgency for Action to Prevent Cancer. A Report to the President of the United States from the President’s Cancer Panel. National Cancer Institute. https://deainfo.nci.nih.gov/advisory/pcp/annualReports/HPV/PDF/PCP_Annual_Report_2012-2013.pdf.

Intervention Results: The Panel recommends three critical goals that must be achieved to increase HPV vaccine uptake in the United States, with the ultimate goal being completion of the full three-dose vaccine series by all age-eligible adolescents for whom the vaccine is not contraindicated. GOAL 1: REDUCE MISSED CLINICAL OPPORTUNITIES TO RECOMMEND AND ADMINISTER HPV VACCINES, GOAL 2: INCREASE PARENTS’, CAREGIVERS’, AND ADOLESCENTS’ ACCEPTANCE OF HPV VACCINES, GOAL 3: MAXIMIZE ACCESS TO HPV VACCINATION SERVICES. The World Health Organization recommends that HPV vaccines be introduced into national immunization programs where prevention of cervical cancer is a public health priority and vaccine introduction is feasible and sustainable. The Panel recommends that the United States collaborate with global partners to support HPV vaccine uptake and other cancer prevention and control activities worldwide.

Conclusion: HPV infections cause nearly 26,000 cases of cancer in the U.S. and more than 600,000 cases worldwide each year. Two safe, effective vaccines can prevent infections with HPV types most commonly associated with cancer. In the United States, these vaccines have been recommended by ACIP for adolescent girls since 2006 and for adolescent boys since 2011.* However, HPV vaccine uptake lags behind that of other adolescent vaccines, leaving millions of young people vulnerable to infection with this cancer-causing virus. Increasing HPV vaccine uptake in the United States should be a public health priority. Successes in other countries and in parts of the United States indicate that this goal is achievable. Targeted interventions are needed to ensure timely progress. In this report, the Panel outlined a multipronged strategy for accelerating U.S. HPV vaccine uptake. All stakeholders in the National Cancer Program should work together and with stakeholders focused on vaccines to promote and facilitate HPV vaccination as an urgent national priority. Key to increasing HPV vaccination in the U.S. is reducing missed clinical opportunities. If all providers strongly recommend HPV vaccines to age-eligible patients, including those receiving other vaccines, uptake of HPV vaccines should increase dramatically. Systems changes should be made, as necessary, to support this recommendation. Also, parents and adolescents should be provided with information about HPV-associated diseases and vaccines so they can make informed decisions. In addition, they should be able to obtain vaccines at convenient locations and from a wider range of providers, including pharmacists. Although the Panel’s charge is focused on the U.S. National Cancer Program, the Panel recognizes the role of the United States in supporting cancer control efforts in other parts of the world, particularly lowand middle-income countries. Moreover, especially in the case of infectious diseases, what happens in one country may influence the health of another. HPV vaccines have the potential to reduce the significant burden of cervical cancer and other HPV-associated cancers in these countries. The United States should continue to collaborate with global partners and find ways to support development of HPV vaccine programs around the world. Continued research on HPV-associated cancers and HPV vaccines is needed to ensure that messages regarding vaccination are effective and that current vaccines are used optimally. Evidence that one or two doses are effective likely would result in major increases in HPV vaccine uptake. Next-generation vaccines that offer broader protection and/or logistical advantages should be pursued. Research is needed to determine how best to integrate HPV vaccination and cervical cancer screening. The Panel is committed to achieving the vision of increased HPV vaccine uptake. In that spirit, the Panel suggests that a credible organization, such as NVAC, be given responsibility for monitoring the status of uptake and implementation of these recommendations. That accountability, in combination with the Panel’s commitment to monitor implementation of recommendations outlined in this report, will increase the likelihood that the report and its recommendations will become agents for change. The ultimate goal is reduction, or even elimination, of preventable HPV-associated cancers in the United States and around the world. This is a goal around which all major cancer and vaccine-related organizations should rally. It is achievable and within our reach.

Study Design: N/A

Setting: The United States

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Patient Reminder/Invitation

Intervention Description: A cohort study with a historical control was carried out with an exposed group, defined as women receiving a letter for recall in the week of November 21–27, 2013, and a non-exposed, control arm of women who did not receive the letter but who would have been eligible for correspondence in the same time period in 2012.

Intervention Results: The study population comprised 5182 women in the exposed group and 4223 women in the non-exposed group. Women receiving the letter were more likely to return to screening, with an aOR of 1.82 (95% CI 1.66–1.99). Other significant factors included being registered with a Patient Enrolment Model family physician and having a series of prior Pap tests in the past screening history.

Conclusion: A correspondence program benefits the retention of women in organized cervical screening programs.

Setting: Organized cervical screening program in Ontario

Population of Focus: Women ages 21-64 who had not received a pap test in the past 2.9 years

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation,

Intervention Description: The intervention involved the use of a short message service (SMS) reminder, termed Flutext-4U, which included a parent-level nudge. The SMS reminder was sent to the child’s primary carer (parent) on behalf of the hospital. Additionally, clinician-level nudges were incorporated into standard practice, including prompt/reminder stickers and medical record bookmarks placed at the relevant clinical notes page for notes entry by the clinician

Intervention Results: The study reported that 600 participants completed the study, with 298 in the intervention group and 302 in the control group. The recruitment and randomization period was from April 15 to August 13, 2021. No adverse events were reported

Conclusion: The study aimed to evaluate the SMS (parent nudge) intervention and its impact on influenza vaccine uptake in children with Special Health Care Needs (CSHCN)

Study Design: The study was a parallel-group randomized clinical trial (RCT)

Setting: The study was conducted at the Women’s and Children’s Health Network (WCHN) from April 15 to September 30, 2021

Population of Focus: Children with Special Health Care Needs (CSHCN)

Sample Size: The study aimed to enroll at least 540 parents of children with Special Health Care Needs (CSHCN) at the WCH

Age Range: Children aged 6 months to 18 years were included in the study

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Enabling Services, Designated Clinic/Extended Hours, PROVIDER/PRACTICE

Intervention Description: (1). to assess the cost-effectiveness of three interventions to deliver breast and cervical cancer screening to women unscreened for >or=3 years and (2). to determine the relation of an invasive cervical cancer diagnosis to the interval since the last true screening test.

Intervention Results: Significantly greater odds of Pap smear for women in phone/phone and letter/phone intervention groups than in control group (phone/phone OR=4.77, letter/phone OR=5.57, p<.0001)

Conclusion: Letter reminder, followed by a telephone appointment call, was the most cost-effective approach to screening rarely screened women. Lack of accurate information on prior hysterectomy adds substantial unnecessary costs to a screening reminder program.

Study Design: RCT

Setting: Portland, OR metropolitan area

Population of Focus: Women who were members of Northwest Kaiser Permanente (NWKP) for at least 3 years, with no history of cervical cancer or hysterectomy, who had not received a Pap smear in the same 3 years they had been members of NWKP

Data Source: Radiology and cytology database

Sample Size: Total (N=1,200) Intervention Group 1 (n=288); Intervention Group 2 (n=308); Intervention Group 3 (n=303); Control (n=301)

Age Range: 18-70

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, Provider/Patient Communication Portal,

Intervention Description: The intervention included portal messages promoting influenza vaccination, listing upcoming clinics, and offering online scheduling of vaccination appointments, as well as interactive voice response calls.

Intervention Results: The interventions led to a significant increase in early influenza vaccination rates among eligible adults in the outpatient population.

Conclusion: The study demonstrated that outreach interventions can effectively improve influenza vaccination rates among eligible adults in an outpatient population.

Study Design: The study was a nonblinded randomized controlled intervention.

Setting: The study was conducted at a large multispecialty medical group in central Massachusetts.

Population of Focus: The target audience was eligible adults in an outpatient population.

Sample Size: The study included 97,007 participants.

Age Range: The age range of the participants was not specified in the article.