Increasing Cancer Screening: One-on-One Education for Clients
One-on-one education delivers information to individuals about indications for, benefits of, and ways to overcome barriers to cancer screening with the goal of informing, encouraging, and motivating them to seek recommended screening. These messages are delivered by healthcare workers or other health professionals, lay health advisors, or volunteers, and are conducted by telephone or in person in medical, community, worksite, or household settings.
These messages can be untailored to address the overall target population or tailored with the intent to reach one specific person, based on characteristics unique to that person, related to the outcome of interest, and derived from an individual assessment. One-on-one education is often accompanied by supporting materials delivered via small media (e.g., brochures), and may also involve client reminders.
Summary of Task Force Recommendations and Findings
The Community Preventive Services Task Force recommends the use of one-on-one education to increase screening for breast and cervical cancers on the basis of strong evidence of effectiveness. The Task Force also recommends the use of one-on-one education to increase colorectal cancer screening with fecal occult blood testing (FOBT) based on sufficient evidence of effectiveness.
Evidence is insufficient, however, to determine the effectiveness of one-on-one education in increasing colorectal cancer screening with other tests, because only two qualifying studies assessed colonoscopy (with inconsistent results), and only one qualifying study assessed flexible sigmoidoscopy (which found no effect).
Results from the Systematic Reviews
The Task Force findings are based on evidence from a previously completed review (search period 1966-2004) and an updated review (search period 2004-2008). Updates of reviews are conducted to incorporate more recent evidence.
The original systematic review included 25 studies with 35 study arms.
- Mammography screening: median increase of 9.2 percentage points (interquartile interval [IQI]: 4.9 to 14.4 percentage points; 31 study arms)
- Results from the four additional study arms were in favor of the intervention. The reported results could not be expressed as percentage point changes.
The update included 9 studies
- Mammography screening: median increase of 11.9 percentage points (range 6.5 to 15.2; 7 study arms)
- Results from two additional study arms with women at higher risk of breast cancer showed 1 to 18 percentage point increases in mammography use.
Combined evidence from both the original and the updated review showed the following.
- Tailored interventions showed a median increase of 9.7 percentage points (IQI: 6.5 to15.2 percentage points; 30 study arms).
- Untailored interventions showed a median increase of 6.3 percentage points (IQI: 2.0 to11.4 percentage points; 9 study arms).
- In studies reporting socio-economic status (SES), one-on-one education programs targeted to lower income women showed greater effects than programs that did not target low income women (10.4 percentage points [IQI: 9.4 to 15.1 percentage points]; 14 study arms versus 8.8 percentage points [IQI 2.0 to 14.4 percentage points]; 26 study arms).
- The incremental effect of one-on-one education when added to other types of interventions was a median increase of 6.1 percentage points (IQI: 2.0 to 11.0; 15 study arms)
Tailored and untailored one-on-one education interventions to increase breast cancer screening should be applicable across a range of settings and populations, provided they are adapted and targeted for a specific population and delivery context.
Five studies, with 8 study arms, were included in the original systematic review. No additional studies were identified during this update.
- Completed Pap tests: median increase of 8.1 percentage points (IQI: 5.7 to 17.3 percentage points; 8 study arms)
Tailored and untailored one-on-one education interventions to increase cervical cancer screening should be applicable across a range of settings and populations, provided they are adapted and targeted for a specific population and delivery context.
Combined evidence from the original and updated reviews included 7 studies with 12 study arms.
- Screening by fecal occult blood test (FOBT): median increase of 19.1 percentage points (IQI: 12.9 to 25.1 percentage points; 10 study arms).
- Screening by a colonoscopy: range from 0 to 11 percentage points increase (2 study arms).
- Screening by flexible sigmoidoscopy: no change reported (1 study arm).
- Screening by any methods: range from 1 to 11 percentage points increase (2 study arms).
- Tailored interventions showed increase ranging from 1 to 20.1 percentage points (2 studies)
- Untailored interventions showed a median increase of 20.7 percentage points (IQI: 13.8 to 25.8 percentage points; 3 studies with 8 study arms)
Tailored and untailored one-on-one education interventions to increase colorectal screening by FOBT should be applicable across a range of settings and populations, provided they are adapted and targeted for a specific population and delivery context.
These findings were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to cancer prevention and control.
The updated search for evidence included nine studies about breast cancer (5 studies), cervical cancer (1 study), or colorectal cancer (3 studies) screening. Monetary values are presented in 2009 U.S dollars.
- Of the nine included studies, eight reported results from actual interventions and one used economic modeling.
- The cost per additional screening ranged from $39 to $5,306, with a median of $534.
- The most expensive intervention was the most resource intensive. Lay health advisors conducted three in-person home visits, made follow-up phone calls, and sent mailings that addressed barriers to screening.
- Analytic Framework – see Figure 1 on page 100 [PDF - 230 kB]
- Evidence Gaps
- Summary Evidence Tables - Effectiveness Review
- Breast Cancer [PDF - 170 kB]
- Colorectal Cancer by Colonoscopy or Flexible Sigmoidoscopy [PDF - 128 kB]
- Colorectal Cancer with Fecal Occult Blood Testing (FOBT) [PDF - 149 kB]
- Summary Evidence Table - Economic Review [PDF - 102 kB]
- Included Studies - Economic Review
- Search Strategy
Sabatino SA, Lawrence B, Elder R, Mercer SL, Wilson KM, DeVinney B, Melillo S, Carvalho M, Taplin S, Bastani R, Rimer BK, Vernon SW, Melvin CL, Taylor V, Fernandez M, Glanz K, Community Preventive Services Task Force. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for The Guide to Community Preventive Services. [PDF - 235 kB] Am J Prev Med 2012;43(1):765-86.
Community Preventive Services Task Force. Updated recommendations for client- and provider-oriented interventions to increase breast, cervical, and colorectal cancer screening. [PDF - 90 kB]. Am J Prev Med 2012;43(1):760-4.
Read other Community Guide publications about Cancer Prevention and Control in our library.
The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.
The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Increasing cancer screening: one-on-one education for clients. www.thecommunityguide.org/cancer/screening/client-oriented/OneOnOneEducation.html. Last updated: MM/DD/YYYY.
Review completed: March 2010
- Page last reviewed: April 19, 2016
- Page last updated: April 19, 2016
- Content source: The Guide to Community Preventive Services