***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Our objective was to assess the efficiency of a home-visit invitation aim ed to increase uptake of cervical cancer screening in women between 35 and 60 years of age . From May , 2006 , we conducted a quasi-r and omized trial to determine if an in-home education and invitation intervention would increase uptake of cervical cancer screening . We r and omly recruited 304 women from the Samliem inner-city community , Khon Kaen , Northeast Thail and , and assigned participants to either the intervention or control zone . Baseline screening coverage interviews were then performed : 58 of 158 women in the intervention zone and 46 of 146 in the control zone were excluded from the study because of having had a Pap smear within 5 years , but these were included in the final analysis . First , 100 women in the intervention group were visited in their homes by one of the research ers , who provided culturally-sensitive health education that emphasized the need for screening . Four months later , post-intervention ,  screening-coverage interviews were again performed in both groups , in combination with the same health education for 100 women in the control group for a comparison . There was no difference in the baseline Pap smear screening-coverage rate in the intervention vs. control zones ( 36.7 vs. 31.5 % , p=0.339 ) . One hundred women in the intervention group completed the intervention interviews and after four months , 100 women in the intervention group and 100 in the control group also completed the post-intervention interviews . The increased screening-coverage rate in the intervention zone was similar to that of the control zone ( 43.6 vs. 34.9 % , p=0.119 ) ; however , there was a borderline significant increase in the intervention zone compared with baseline ( 36.7 to 43.6 % , p=0.070 ) . Therefore , home visit education and invitation intervention produced only a nominal effect on increasing Pap smear coverage within a 4-month study period INTRODUCTION Southeast Asian women have low levels of Papanicolaou ( Pap ) testing participation  . We conducted a group-r and omized controlled trial to evaluate a cervical cancer screening intervention program targeting Seattle 's Cambodian refugee community . METHODS Women who completed a baseline , community-based survey were eligible for the trial . Neighborhoods were the unit of r and omization . Three hundred and seventy survey participants living in 17 neighborhoods were r and omized to intervention or control status .  Intervention group women received home visits by outreach workers and were invited to group meetings in neighborhood setting s. The primary outcome measure was self-reported Pap testing in the year prior to completing a follow-up survey . RESULTS The proportion of women in the intervention group reporting recent cervical cancer screening increased from 44 % at baseline to 61 % at follow-up ( + 17 % ) . The corresponding proportions among the control group were 51 and 62 % ( + 11 % ) . These temporal increases were statistically significant in both the intervention ( P < 0.001 ) and control ( P = 0.027 ) groups . DISCUSSION This study was unable to document an increase in Pap testing use specifically in the neighborhood-based outreach intervention group ; rather , we found an increase in both intervention and control groups . A general awareness of the project among women and their health care providers as well as other ongoing cervical cancer screening promotional efforts may all have contributed to increases in Pap testing rates The Singapore Breast Screening Project was a nationwide study inviting a r and om sample of women between the ages of 50 and 64 years for mammography at one of two hospital-based screening centres over two years . The current study was undertaken to determine if ( 1 ) mailed health educational material alone , or ( 2 ) the same material delivered during a home visit made to the subject and her family would increase the uptake among Singapore women who had not responded to two previous invitations for mammographic screening as part of the Project . This r and omized trial employed a st and ard second reminder letter ( R ) , the same letter packaged with health education material design ed for the project ( RP ) and the addition of a home visit to make contact with the woman and her family ( RV ) . The outcome measure of interest was the proportion of women in each group subsequently attending for screening .  The study population comprised 1500 non-attenders whose names appeared consecutively in the data base of the larger screening centre in this Project . These were r and omized into three groups of 500 each . In total , they broadly resembled the national population in ethnic composition ( 72.3 % Chinese , 17.8 % Malays , 9.0 % Indians and 0.8 % Others ) . By the end of the project , 7.0 % of women in group R and 7.6 % in group RP responded to the invitation . In group RV , 428 homes were visited at least once and contact was made with the subject and her family member in 306 ( 71.5 % ) cases . Subsequently , 13.3 % of the women visited attended for screening . The rate ratio for attendance in group RP compared with group R was 1.09 ( 95 % CI 0.70 to 1.70 ) and for group RV compared with R , 1.90 ( 1.27 to 2.84 ) . When analyzed by groups originally assigned to , women in group RV remained significantly more likely to attend than those in groups R or RP . The marginal cost of a home visit , based on this study , was $ 25.04 per additional woman screened . Our results suggest that the response to a second reminder is generally low and that additional print material does not improve screening attendance in this group of initial non-attenders . Personal contact with the family through a home visit appears to increase uptake , and may be helpful particularly among women who have less frequent contact with the health care system Objective : Despite the proven survival benefits associated with cervical cancer screening , use of the Pap test continues to be suboptimal in some population subgroups , such as among Korean-American women who face considerable barriers to screening . Therefore , we evaluated a multifaceted intervention that combined psychoeducational counseling with patient navigation to address both psychosocial and access barriers to screening . Method : Women ( n = 102 ) were recruited from Korean community centers and assigned to the intervention or control condition . The intervention group received cervical cancer education and patient navigation delivered by bilingual Korean health educators . The control group received general health education , including information about cervical cancer and screening . Assessment s were obtained at baseline and postintervention . Screening behavior was assessed at 6 months postintervention . Results : At baseline , 17 % of participants reported having had a Pap test in the previous year . At 6 months postintervention , 83 % of women in the intervention group had obtained screening compared with 22 % in the control group , χ2(1 ) = 41.22 , P < 0.001 . Multivariate logistic regression analyses indicated that participation in the intervention was associated with screening ( P < 0.001 ) . Fewer psychosocial barriers ( e.g. , discomfort at having a stranger perform Pap ) and greater self-efficacy were also associated with screening ( P < 0.05 ) . Conclusion : A combined modality intervention that delivers education with patient navigation training and assistance result ed in increased screening rates . Multifaceted approaches may be effective in reducing the psychosocial , access , and language barriers that contribute to cancer health disparities in underserved population s. ( Cancer Epidemiol Biomarkers Prev 2007;16(6):1–5 This study assessed the effectiveness of a theory-based direct mail campaign in encouraging non-compliant women , aged 30 and older or younger if married , to obtain a Pap test . Participants were female family members of in patients admitted to one of the major teaching hospitals in Taiwan during August – September 1999 . A total of 424 women were recruited in the r and omized intervention trial . Three months following implementation of the intervention , women in the intervention group reported a higher rate of Pap test screening than women in the comparison group ( 50 % versus 32 % ) ( p = 0.002 ) . Women in the intervention group also showed higher perceived pros of a Pap test at follow-up ( p = 0.031 ) . Although women in both groups showed an increased knowledge and intention to obtain a Pap , only the intervention group had significantly higher follow-up scores on perceived pros and susceptibility . The results shows that the intervention was effective in increasing Pap test screening  among Chinese women within three months . The results also support the use of Intervention Mapping , a systematic program development framework for planning effective interventions OBJECTIVE We conducted a cluster r and omized clinical trial to compare the benefit of offering on-site mobile mammography in addition to an outreach program design ed to increase mammography use by educating patients . SUBJECTS AND METHODS We recruited a consecutive volunteer sample of 499 women ranging in age from 60 to 84 years who had not undergone mammography in the previous year to participate in a cluster r and omized clinical trial about the benefit of on-site mobile mammography .  Subjects were recruited from 60 community-based sites where seniors gather . The intervention included a structured on-site multicomponent educational program with or without available on-site mobile mammography . The primary outcome measure was self-reported receipt of mammography within 3 months of the intervention . RESULTS Women in the group offered access to on-site mammography and health education were significantly more likely than those in the group offered health education only to undergo mammography  within 3 months ( 55 % vs 40 % , p = 0.001 ; adjusted [ for clustering ] odds ratio , 1.83 ; 95 % confidence interval , 1.22 - 2.74 ) . Gains from offering on-site  mammography  were shown for several ethnic and sociodemographic subgroups and were especially large for Asian American women . CONCLUSION Offering on-site mammography at community-based sites where older women gather is an effective method for increasing breast cancer screening rates among older women and may be particularly effective for some subgroups of women who traditionally have had low screening rates Abstract Objectives : To determine whether a two hour training programme for general practice reception staff could improve uptake in patients who had failed to attend for breast screening , and whether women from different ethnic groups benefited equally . Design : Controlled trial , r and omised by general practice . Setting : Inner London borough of Newham . Subjects : 2064 women aged 50–64 years who had failed to attend for breast screening . Women came from 26 of 37 eligible practice s. 31 % were white , 17 % were Indian , 10 % Pakistani , 14 % black , 6 % Bangladeshi , 1 % Chinese , 4 % were from other ethnic groups , and in 16 % the ethnic group was not reported . Main outcome measures : Attendance for breast screening in relation to ethnic group in women who had not taken up their original invitation . Results : Attendance in the intervention group was significantly better than in the control group ( 9 % v 4 % ) . The response was best in Indian women — it was 19 % in the intervention group and 5 % in the control group . Conclusions : This simple , low cost intervention improved breast screening rates modestly . Improvement was greatest in Indian women — probably because many practice staff shared their cultural and linguistic background . This intervention could be effective as part of a multifaceted strategy to improve uptake in areas with low rates . Key messages The uptake of breast screening is inadequate and inequitable in some deprived areas —often those with large minority ethnic population s Training general practice receptionists to contact women who had not responded to an initial invitation for breast screening made a small but important improvement in attendance Improvement was most pronounced among Indian women — perhaps because most practice s employed staff who spoke an Indian language Re sources of local general practice s could be used as part of multifaceted programmes to increase screening rates in areas of low uptake BACKGROUND Chinese North American women have high invasive cervical cancer rates and low screening rates . The cost-effectiveness of strategies to improve Pap testing rates for Chinese women living in Seattle , Washington and Vancouver , British Columbia was examined . OBJECTIVES To calculate the costs and cost-effectiveness of implementing two strategies to motivate women to obtain a Pap smear . RESEARCH DESIGN A three-armed r and omized , controlled trial was conducted . Women in each of two interventions ( high-intensity outreach and low-intensity mailing intervention ) were compared to a group of women who received usual care . MEASURES Costs were captured via a group discussion of costs , accounting records , sampling of staff time logs , and estimation of costs and task times . Effectiveness was measured as the proportion of women in each intervention arm who reported receiving a Pap smear since the trial began . Cost-effectiveness was calculated as the incremental cost of screening each additional woman between an intervention arm and the control arm . RESULTS A greater percentage of women who received the outreach intervention had a Pap test than women who received mailed material s or women who were in the usual care arm . The intent-to-treat cost for each additional woman to be screened for a Pap test was $ 415 in the Outreach arm and $ 676 for the Direct Mailing arm . The outreach worker intervention , though more expensive overall , was more cost-effective than the mailing intervention . CONCLUSIONS Outreach intervention is cost-effective for sponsors and should be considered as a strategy to motivate Chinese women living in North America to seek cervical cancer screening BACKGROUND North American Chinese women have lower levels of Papanicolaou ( Pap ) testing than other population subgroups . We conducted a r and omized controlled trial to evaluate the effectiveness of two alternative cervical cancer screening interventions for Chinese women living in North America . METHODS Four hundred and eighty-two Pap testing underutilizers were identified from community-based surveys of Chinese women conducted in Seattle , Washington , and Vancouver , British Columbia . These women were r and omly assigned to one of two experimental arms or control status . Several Chinese 
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This observed pattern of intervention design supports the hypothesis that employing a combination of multiple strategies is more likely to be successful than single interventions .
The effectiveness of community-based or workplace-based group education programs increases when additional supports , such as assistance in scheduling/attending screening and mobile screening services are provided .
Combining cultural awareness training for health care professionals with outreach workers who can help healthcare professionals overcome language and cultural barriers is likely to improve cancer screening uptake .
Media campaigns and mailed culturally sensitive print material s alone may be ineffective in increasing screening uptake .
Intervention effectiveness appears to vary with ethnic population , methods of program delivery , and study setting .
Conclusions Despite some limitations , our review has demonstrated that the effectiveness of existing interventions to promote breast and cervical cancer screening uptake in Asian women may hinge on a variety of factors , such as type of intervention and study population characteristics .