Find Established Evidence

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): Assessment
Intervention Description: The committee met five times within six months. The committee held three open information-gathering sessions at which the members heard from a diverse group of stakeholders, researchers, members of advocacy organizations, and the public. Box S-2 provides the committee definition of preventive health services. The committee’s methodology to identify preventive services necessary for women’s health and well-being and to identify specific services that could supplement the current list of recommended preventive services for women under the ACA follows. The committee’s first step was to review and reach an understanding of existing guidelines. The second step was to assemble and assess additional evidence, including reviews of the literature, federal health priority goals and objectives, federal reimbursement policies, and the clinical guidelines of health care professional organizations. The committee also considered the public comments that it received. Finally, the committee formulated a list of recommendations to be considered by the Secretary of HHS in developing a comprehensive package of preventive services for women to be included under the ACA.
Primary Outcomes: N/A
Conclusion: Bringing clinical preventive services into rational alignment with the coverage for other health care services under the ACA will be a major task. The committee notes that many of the individual components for review of the evidence are already managed within HHS but currently lack effective coordination for the purposes outlined in the ACA and that some functions are entirely new. The structure might be effectively built over time by using some current bodies and adding new ones as resources permit. The committee does not believe that it has enough information to recommend which unit in HHS should implement the recommendations. Figure S-1 illustrates the committee’s suggested structure. In view of the critical importance of community-based preventive services in achieving clinical aims, the committee encourages the Secretary to consider widening the scope of authority to include public health efforts to more comprehensively address prevention. It will be critical for a preventive services coverage commission to coordinate with the new and existing committees that are charged with overseeing other elements of the ACA. Finally, the committee notes that it would make the most sense to consider preventive services for women, men, children, and adolescents in the same way. Thus, although the committee’s recommendations address women’s preventive services, a parallel approach could be equally useful for determining covered preventive services for men, children, and male adolescents.
Study Design: N/A
Significant Findings: N/A
Setting: N/A
Data Source: Existing Guidelines
Sample Size: N/A
Age Range: N/A

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): Organizational Changes
Intervention Description: N/A
Primary Outcomes: N/A
Conclusion: To increase cancer screening completion goals, OC interventions should be implemented tailored to the primary care practice style. Interventions that circumvent the physicians were more effective. We could not conclude whether or not continuous quality techniques were effective. Further research is needed to evaluate cost-effectiveness of these interventions.
Study Design: Systematic Review
Significant Findings: No
Setting: Not specified
Data Source: Used the National Library of Medicine online database to identify Randomized Controlled Trials (RCT), meta-analyses, and systematic reviews related to OC strategies in primary care practices. Searched Pubmed using combinations of the search terms neoplasm, prevention and control, mass screening, organizational innovation, organizational objectives, preventive health services, organization and administration.
Sample Size: 11 studies
Age Range: Not specified

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): Other Education
Intervention Description: Thirteen studies were included.
Primary Outcomes: N/A
Conclusion: Personalised risk communication (as currently implemented in the included studies) is associated with increased uptake of screening programmes, but this may not be interpretable as evidence of informed decision making by consumers.
Study Design: Systematic Review of 13 RCT
Significant Findings: Yes
Setting: Not specified
Data Source: Two reviewers independently assessed trial quality and extracted data. Data about the nature and setting of the intervention, and the relevant outcome data were extracted, along with items relating to methodological quality.
Sample Size: 13 studies
Age Range: Not specified

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Counseling (Parent/Family)
Intervention Description: Thirty-eight trials met our inclusion criteria. These trials assessed the effectiveness of invitational and educational interventions, counselling, risk factor assessment and procedural interventions. Heterogeneity between trials limited statistical pooling of data.
Primary Outcomes: N/A
Conclusion: There is evidence to support the use of invitation letters to increase the uptake of cervical screening. There is limited evidence to support educational interventions but it is unclear what format is most effective. The majority of the studies are from developed countries and so the relevance to developing countries is unclear.
Study Design: Systematic Review of 38 RCT
Significant Findings: Yes
Setting: Not specified
Data Source: searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Issue 1, 2009. MEDLINE, EMBASE and LILACS databases up to March 2009.
Sample Size: 38 studies
Age Range: Not specified

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): Other Person-to-Person Education, Patient Navigation
Intervention Description: A qualitative study design included: (i) a systematic review, in which 1,301 abstracts from five databases were screened and 41 publications included; (ii) soliciting 124 unpublished documents from governments and partner institutions; and (iii) conducting 27 key informant interviews. Data were extracted and analysed thematically. Additionally, first-dose coverage rates were categorised as above 90 %, 90–70 %, and below 70 %, and cross-tabulated with mobilisation timing, message content, materials and methods of delivery, and consent procedures.
Primary Outcomes: N/A
Conclusion: Despite some challenges in obtaining parental consent and addressing rumours, experiences indicated effective social mobilisation and high HPV vaccine acceptability in LMICs. Social mobilisation, consent, and acceptability lessons were consistent across world regions and HPV vaccination projects/programmes. These can be used to guide HPV vaccination communication strategies without additional formative research.
Study Design: A qualitative study design
Significant Findings: Yes
Setting: Not specified
Data Source: A qualitative study design included: (i) a systematic review, in which 1,301 abstracts from five databases were screened and 41 publications included; (ii) soliciting 124 unpublished documents from governments and partner institutions; and (iii) conducting 27 key informant interviews.
Sample Size: 1452 studies/ abstracts reviewed/ interviews
Age Range: Not specified

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Access
Intervention Description: This review article provides a conceptual framework for human papillomavirus (HPV) vaccine acceptance and adherence, with a focus on improving understanding of the sociocultural factors impacting vaccine adherence behaviour. We include a systematic review of the slowly expanding literature on HPV vaccine acceptability and uptake in developed nations, as well as the relatively few publications from poorer nations, where more than 80% of global cervical cancer related deaths occur and where the vaccine will probably have the largest impact.
Primary Outcomes: N/A
Conclusion: "By developing a conceptual framework for HPV vaccine adherence, we hope to inform future research on vaccine adherence among adolescents at high risk for STI acquisition. The analytic construct proposed here recognises forces such as structural and sociocultural factors effecting vaccine uptake and incorporates them into the model. This model also takes into account the target population and the role that caregiver involvement will play in acceptance of this vaccination. It is provides a future direction for research. We caution readers that most reviewed studies, when considered on their own, yield evidence of inadequate quality to direct future interventions. We do believe, however, that this work, taken in combination with other health behaviour theories and a body of empirical literature that continues to expand on HPV vaccine uptake and adherence, suggests that programs promoting vaccine uptake and adherence would benefit from optimising educational messaging (vaccine effectiveness) while addressing important sociocultural barriers for both adolescents and their caregivers. Ultimately, we believe our proposed conceptual model will aid in future research aimed at understanding barriers to vaccine uptake and adherence, and ultimately provide further information about means to overcome them, thus enabling millions to receive the benefits of vaccination."
Study Design: Systematic Review
Significant Findings: Yes
Setting: Not specified
Data Source: "For our literature review, the lead author searched PubMed/MEDLINE and other electronic databases from 1995 to 2009 (the approximate time frame during which HPV was known to cause cervical cancer), as well as electronic conference proceedings of the recent HPV-related conferences, for articles related to HPV vaccine uptake and adherence. The focus was on likely barriers and facilitators, identified from behavioural theory, among adolescents and their caregivers. Since federal approval of the vaccine was not granted until 2007, we were only able to examine actual uptake in the latter years of our search. Search terms included: human papillomavirus (and variants such as HPV); AND adherence* and attitude* and uptake* and barrier* and knowledge* and risk perception*; AND vaccine*. We also searched the reference sections of included articles."
Sample Size: 400 studies
Age Range: Not specified

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, Other Person-to-Person Education
Intervention Description: The purpose of this study was to provide a review of the literature on HPV vaccination uptake and completion rates among female minority adolescents as well as a discussion of the financial and policy dimensions of HPV vaccination with implications that impact uptake and completion rates.
Primary Outcomes: N/A
Conclusion: The authors recommend that nurses and advanced practice nurses take an active role at the point of care to educate families about HPV vaccination. Nursing interventions for practice changes are provided to improve vaccination initiation and completion rates in disadvantaged populations.
Study Design: Literature Review
Significant Findings: Yes
Setting: Not specified
Data Source: Online database
Sample Size: N/A
Age Range: Not specified

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): Feedback, Educational Material, Patient Reminder/Invitation
Intervention Description: "We used a PubMed search to identify studies that assessed interventions that looked at provider assessment and feedback, provider reminders, client reminder and recall, and clinic based education programs."
Primary Outcomes: N/A
Conclusion: There is evidence to support the application of the Community Preventive Services Task Force recommendations specifically to HPV vaccination both for client reminder and recall programs and for provider assessment and feedback interventions. Multiple targeted approaches will be needed to substantially impact HPV vaccine rates.
Study Design: Systematic Review
Significant Findings: No
Setting: Not specified
Data Source: PubMed Database
Sample Size: 13 studies
Age Range: Not specified

NPM: 1: Well-Woman Visit
Intervention Description: N/A
Primary Outcomes: N/A
Conclusion: N/A
Study Design: N/A
Significant Findings: N/A
Setting: N/A
Data Source: N/A
Sample Size: N/A
Age Range: N/A

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage
Intervention Description: The present study uses a quasi-experimental design using data from the California Women's Health Survey and the Behavioral Risk Factor Surveillance System (BRFSS) for exposure and comparison groups, before and after California's Planning Access Care and Treatment waiver.
Primary Outcomes: Percentage of women with a Pap smear in the past year
Conclusion: The waiver appears to have led to a reduction in pregnancy rates and increased receipt of reproductive health care, particularly routine checkups.
Study Design: QE: pretest-posttest non-equivalent control group
Significant Findings: No
Setting: California
Target Audience: Women in California with incomes under 200% of the Federal Poverty Level (FPL)
Data Source: California Women’s Health Survey and Behavioral Risk Factor Surveillance System
Sample Size: California Women’s Health Survey: Pre-waiver Intervention group ranges from n=220 to n=1,971 Control group ranges from n=206 to n=1,598 Post-waiver Intervention group ranges from n=399 to n=4,123 Control group ranges from n=497 to n=2,782 Behavioral Risk Factor Surveillance System: Pre-waiver Intervention (n=1,735); Control (n=2,564) Post-waiver Intervention (n=3,750); Control (n=10,963)
Age Range: 18-44

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage
Intervention Description: The authors prospectively followed a representative panel of 16,204 individuals from the Oregon Medicaid lottery reservation list, collecting data before and after the Medicaid lottery drawings. The study panel was divided into 2 groups: a treatment group of individuals who were selected in the Medicaid lottery (6254 individuals) and a control group who were not (9950 individuals). The authors also created an elevated risk subpanel based on family cancer histories. One year after the lottery drawings, differences in cancer screening rates, preventive behaviors, and health status were compared between the study groups.
Primary Outcomes: 1) Percentage of women who self-reported receiving a Pap test within the last year 2) Percentage of women who self-reported having received the HPV vaccine 12 months following the intervention
Conclusion: Medicaid coverage did not appear to directly impact lifestyle choices that might reduce cancer risk, but it did provide access to important care and screenings that could help to detect cancers earlier. These findings could have long-term population health implications for states considering or pursuing Medicaid expansion. Cancer 2016;122:791-797. © 2015 American Cancer Society.
Study Design: Prospective RCT
Setting: Oregon
Target Audience: Low-income, nondisabled, uninsured females who signed up for the Oregon Medicaid lottery reservation list7 Elevated risk subpanel: participants who reported, either for themselves or a close relative, a prior diagnosis of breast, ovarian, uterine, colon, or prostate cancer
Data Source: 1) Computerized administrative data 2) Written surveys distributed via mail
Sample Size: Total Panel at Baseline (n=4,023)8  Intervention (n=1,526)  Control (n=2,497) Elevated Risk Subpanel at Baseline (n=1,042)  Intervention (n=410) Control (n=632)
Age Range: 18-31

NPM: 1: Well-Woman Visit
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.
Primary Outcomes: Percentage of women with a registered Pap smear within 90 days of sending the invitation
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
Significant Findings: No
Setting: Sweden
Target Audience: 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

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education
Intervention Description: Six hundred thirteen women of Mexican origin in 3 treatment sites were randomized among 4 study arms: the full AMIGAS program with a video and a flip chart (n = 151), the AMIGAS program without the video (n = 154), the AMIGAS program without the flip chart (n = 155), and a usual care control group (n = 153). Six months after enrollment, women were surveyed and reported whether or not they had been screened.
Primary Outcomes: Percentage of women with a self-reported Pap smear at the 6-month follow-up
Conclusion: AMIGAS was effective in increasing Pap test screening among women of Mexican descent when used in a 1-to-1 setting. Future research should compare the 1-on-1 intervention with the group-based intervention.
Study Design: RCT: pretest-posttest
Significant Findings: Yes
Setting: El Paso, TX; Houston, TX; and Yakima Valley, WA
Target Audience: Mexican women with no Pap smear reported in the past 3 years
Data Source: Self-report and validated through medical records review
Sample Size: Intent-to-Treat Analysis (n=613) Intervention Group 1 (n=151); Intervention Group 2 (n=154); Intervention Group 3 (n=155); Control (n=153) Per-Protocol Analysis (n=513) Intervention Group 1 (n=128); Intervention Group 2 (n=125); Intervention Group 3 (n=127); Control (n=133)
Age Range: ≥21

NPM: 1: Well-Woman Visit
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.
Primary Outcomes: Percentage of women with a registered Pap smear within 12 months of study group assignment
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
Significant Findings: Yes
Setting: Two urban community health centers in Houston, TX
Target Audience: 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

NPM: 1: Well-Woman Visit
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).
Primary Outcomes: Percentage of women with a registered Pap smear within 12 months of study group assignment
Study Design: RCT
Significant Findings: Yes
Setting: Two urban community health centers in Houston, TX
Target Audience: 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

NPM: 1: Well-Woman Visit
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.
Primary Outcomes: Odds of receiving a Pap smear within 6 months of the letter mailing date
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
Significant Findings: Yes
Setting: Cape Breton Island and Mainland Nova Scotia
Target Audience: 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

NPM: 1: Well-Woman Visit
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.
Primary Outcomes: Pap test rates at the 90-day follow-up
Conclusion: Being sent a reminder letter is associated with higher Pap testing rates in under-screened women.
Study Design: RCT
Significant Findings: Yes
Setting: New South Wales
Target Audience: 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

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Provider Education
Intervention Description: A three‐year intervention targeting Vietnamese physicians in solo practice in California.
Primary Outcomes: Yearly physician Pap test performance rates
Conclusion: The results demonstrate the efficacy of an intervention targeting Vietnamese primary care physicians in promoting smoking cessation counseling, Pap testing, and pelvic examinations, but not other cancer prevention activities.
Study Design: RCT
Significant Findings: Yes
Setting: Private practices with physicians who were members of the Vietnamese Physicians’ Associations in Northern and Southern CA
Target Audience: Physicians in solo practice who had received their medical training in Vietnam
Data Source: Physicians’ medical records
Sample Size: Total (N=48) Analysis (n=20) Intervention (n=9); Control (n=11) N=physicians
Age Range: N/A

NPM: 1: Well-Woman Visit
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education
Intervention Description: The current study is a randomized trial of a promotora-led educational intervention focused on cervical cancer in a local Hispanic community.
Primary Outcomes: Percentage of women who self-reported receiving a Pap smear in the past year, at the 6-month follow-up
Conclusion: The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable populations about the diseases that disproportionately affect them.
Study Design: RCT: pretest-posttest
Significant Findings: Yes
Setting: South Philadelphia, PA
Target Audience: Hispanic women
Data Source: In-person interview administered in Spanish by the promotoras
Sample Size: Total (N=120) Intervention (n=60); Wait-List Control (n=60) Analysis (n=70) Intervention (n=34); Wait-List Control (n=36)
Age Range: 18-65

NPM: 1: Well-Woman Visit
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.
Primary Outcomes: Odds of having received a Pap test at study completion
Conclusion: LHA interventions show promise for improving screening behaviors among non-adherent women from underserved populations.
Study Design: RCT
Significant Findings: No
Setting: Fourteen Ohio Appalachian clinics
Target Audience: 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