Is the Phone Call the Most Effective Method for Recall in Cervical Cancer Screening? - Results from a Randomised Control Trial


Objective: To compare the effectiveness of different methods of recall for repeat Pap smear among womenwho had normal smears in the previous screening. Design: Prospective randomized controlled study. Setting:All community clinics in Klang under the Ministry of Health Malaysia. Participants: Women of Klang whoattended cervical screening and had a normal Pap smear in the previous year, and were due for a repeat smearwere recruited and randomly assigned to four different methods of recall for repeat smear. Intervention: Therecall methods given to the women to remind them for a repeat smear were either by postal letter, registeredletter, short message by phone (SMS) or phone call. Main Outcome Measures: Number and percentage of womenwho responded to the recall within 8 weeks after they had received the recall, irrespective whether they had Paptest conducted. Also the numbers of women in each recall method that came for repeat Pap smear.
Results: Therates of recall messages reaching the women when using letter, registered letter, SMS and phone calls were 79%,87%, 66% and 68%, respectively. However, the positive responses to recall by letter, registered letter, phonemessages and telephone call were 23.9%, 23.0%, 32.9% and 50.9%, respectively (p<0.05). Furthermore, morewomen who received recall by phone call had been screened (p<0.05) compared to those who received recall bypostal letter (OR=2.38, CI=1.56-3.62).
Conclusion: Both the usual way of sending letters and registered lettershad higher chances of reaching patients compared to using phone either for sending messages or calling. Theresponse to the recall method and uptake of repeat smear, however, were highest via phone call, indicating theimportance of direct communication.