Behavioural Science Messages in Breast Cancer Screening
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Study type: Interventional

Summary: 
      Breast cancer is the most common cancer in the United Kingdom, with 1 in 8 women affected
      during their lifetime. Whilst survival rates are high, the 5-year survival rate is 72% higher
      with the earliest stage breast cancer, compared to the latest disease stage. The National
      Health Service Breast Screening Programme invites women aged 50 to 70 years old every three
      years to a mammogram. By enabling earlier detection, it is estimated that the National Health
      Service Breast Screening Programme saves 1300 lives per year.

      Despite the potential benefits of breast cancer screening, attendance is falling. Behavioural
      Science is a field of study concerning understanding the processes underpinning human action.
      Behavioural theories, such as the Capability Opportunity Motivation-Behaviour model. Recent
      studies have shown the application of behavioural science to screening may also facilitate
      uptake of invitations. However, the use of plain text messages limits which behavioural
      determinants can be feasibly addressed, and what techniques can be used. Video messages can
      allow for more complex and a broader range of behavioural change techniques to be
      incorporated, and therefore have greater impact upon attendance.

      Whilst behavioural science-informed messages have previously been trialled by groups to
      facilitate breast screening attendance, their effectiveness has been variable. One of the
      reasons for this, is that text messages are of limited length and formatting capability, thus
      restricting the number of behavioural channge techniques that can be included. Moreover, some
      behavioural techniques are more complex than others, and plain text can limit the extent to
      which these can be feasibly incorporated. Video messaging provides a delivery mechanism that
      may enable more complex, and different combinations to be trialled. There is however, a
      paucity of data regarding the impact of sending a video-based behavioural science message
      upon attendance rates at breast cancer screening programmes. This study looks to investigate
      the impact of a video-message, compared to behavioural science-based text messages and
      standard reminder messages.

      The primary object is to determine the impact of behavioural science informed (1) video and
      (2) text messages compared to usual care, upon uptake of breast cancer screening. Secondary
      objectives involve how this impact on attendance differs between population subgroups
      including people from differing demographic groups.
    

Detailed description: 
      This study will be conducted as a randomised control trial in the London screening region of
      the National Health Service Breast Screening Programme. The study will last over 6 months.
      The administrative hub for the National Health Service Breast Screening Programme. in London
      is based at the Royal Free Hospital, who will oversee invitation scheduling, message delivery
      and outcome data collation through their existing delivery systems.

      Participants will be randomised using simple randomisation method in a 1:1:1 fashion to
      either intervention arm or usual care. Randomisation will utilise a computerised system in
      which each participant who is due for screening in the study period is randomly allocated a
      number corresponding to the message they will receive. This will be undertaken by the
      screening hub, and will be passed on to the message delivery service who will ensure the
      correct template is sent.

      Written invitations are sent, as standard practice, by the National Health Service Breast
      Screening Programme. to invite women to either (1) an appointment at a set time, date and
      location (so-called timed invitations) or (2) to call and book an appointment (or open
      invitation). Following this, as part of usual care, those selected for open invitations will
      receive a first text message 7 days post written invitation. They will then receive two text
      message reminders, 7 days and 2 days prior to the appointment, once it has been booked. Those
      who receive timed invitations will just receive the two reminder messages, 7 and 2 days prior
      to the appointment. The decision to offer an individual a timed or open invitation is made by
      the screening service based on their pandemic recovery process, and will not be altered by
      this project.

      This randomised controlled trial will involve randomising participants to receive the usual
      care messages (according to the timings outlined above), a plain text message incorporating
      or the behavioural message with a new link to a video incorporating more behavioural
      techniques.

      The content of the intervention messages, and the video have been developed through extensive
      Patient and Public Involvement and Engagement work including 10 interviews, 2 focus groups
      and 2 co-design workshops. Members of the public have been consulted throughout the process,
      especially regarding the representations of individuals in the video, and the message
      content. The feedback received has been used to alter the materials, and further feedback
      received. Through this iterative approach we have ensured content is appropriate. We have
      also sought feedback from members of community groups working in mental health services
      specifically for African Caribbean and Arabic Speaking adults, and trans-led organisation to
      improve the quality of life of trans people, to ensure individuals from these groups are
      happy with representations. Screening commissioners at National Health Service England have
      also approved this content. The National Health Service Identity team have provided approvals
      for the use of National Health Service logos/branding, and the team at London Northwest
      Healthcare National Health Service Trust approved the use of their name.

      The video will be hosted on a private page on the Imperial College London website, which will
      be available only to those who have been sent the link. The video will be translated into
      several languages, with voice overs also available in different languages, to ensure people
      from a diverse background are able to understand the content.

      After 3 months from the initial written invitations, data will be collated from the breast
      screening hub regarding whether an individual attended an appointment and whether the
      messages were successfully sent. This will be repeated at 6 months corresponding to the key
      performance indicator of the service.
    

Intervention name(s): Behavioural Message; Behavioural Message + Video; Usual Care Message
Intervention type(s): Behavioral; Behavioral; Other
Intervention description(s): Messaging involving increased salience, increasing positive emotions and information on health consequences; Messaging as above. The video also includes information on emotional consequences, problem solving, anticipated regret, reducing negative emotions and credible source techniques.; Standard usual care message involving link to non-behavioural science informed video
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 3 arm randomised controlled trial
Masking: Single (Care Provider)
Primary purpose: Screening
Keywords: Breast Cancer Screening; Behavioural Science; Mobile Messaging; Behavioural Interventions; Healthcare Inequalities