Caja Further Consolidates a Behavioural Approach to Increasing Cervical Screening Uptake


Caja is developing significant experience in the application of behavioural science principles to increase uptake of cervical cancer screening. When looking to improve patient outcomes for entire populations, there is often need to focus on addressing specific health inequalities within those communities. Indeed, early cancer diagnosis is one of the five key clinical areas for the NHS Core20PLUS5 initiative.

Over the last 2 years, Caja has been developing and refining an approach to address inequalities in early cancer diagnosis by using behavioural science nudge techniques to promote screening attendance. Much of this work has been focussed specifically on uptake of cervical screening.

To address this issue, we have developed a toolkit for targeting non-responders (individuals who have not booked a screening appointment following receipt of their national invite). This toolkit has been designed for use by GP Practices and comprises of 3 key assets:

  1. Semi-scripted opportunistic help to book conversations.
  2. Revised targeted non-responder letters.
  3. Tailored SMS reminder messages.

Each of these assets incorporates a number of nudge techniques, including social norms, priming, defaults, and loss aversion, to maximise the impact of every patient-service interaction.

Success stories following the implementation of this approach are gathering significant pace. Working with the South Yorkshire and Bassetlaw Cancer Alliance we helped practices achieve an average increase in uptake of 27%. Trialling a similar approach in just two practices in Braford saw increases of up to 58%. Most recently, work with the West Yorkshire and Harrogate Cancer Alliance to expand those trials to over 30 practices in West Yorkshire have led to our latest success. Recent data from Kirklees has shown that using these same assets, practices have averaged a monthly increase in screening of 16%.

Throughout these trials we have placed keen focus on targeting specific areas of inequality, including highly deprived populations, women of South Asian ethnicity, and members of Roma and Traveller communities and believe that our results continue to show the promise of scaling up this approach further and wider.

To find out more about the application of behavioural science in a primary care setting, be sure to join Caja Director, Nigel Guest, as he speaks at the 2023 Best Practice Event.