Testing messages from behavioral economics to improve participation in a population-based colorectal cancer screening program in Cyprus: Results from two randomized controlled trials

Despite the benefits of colorectal cancer (CRC) screening, participation compares poorly to other screening programs. This study assessed the effectiveness of adding different behavioral economic-based messages, to the invitation letter, to increase uptake in the Cypriot CRC screening program. We performed two randomized controlled trials. In the first trial (‘Trial 1’),3212 individuals, aged 50 to 69 years, were randomly allocated (1:1:1:1:1:1:1) to one of six intervention groups, or the control. The intervention groups received the standard invitation letter received by the control, with the addition of one of six messages based on the following behavioral economics principles: (1) social responsibility, (2) anticipated regret, (3) financial opportunity costs (of non-attendance), (4) benefit (of early detection), (5) scarcity effect (limited duration of the offer) and (6) social norms. The second trial (‘Trial 2’) tested the most efficacious message (social responsibility) against the control in a larger sample (N=3074). In both trials, the primary outcome was uptake eight weeks after the screening invitation. In trial 1, overall uptake was 20.6%. There were no significant differences between the control and the intervention conditions (all p’s>0.05). Highlighting the social consequences of cancer did, however, increase uptake rates among women (25.6% vs. 17.1%, aOR 1.67; 95% CI 1.05-2.66, p=0.031). We, therefore, tested this message in Trial 2. Uptake was similar to trial 1 with 20.7% and there was no impact on overall or female uptake (all p’s>0.05). This study demonstrates the importance of testing interventions leveraging behavioral economics principles in real-world settings.

STOFFEL Sandro;  KIOUPI Stala;  IOANNOU Despina;  KERRISON Robert;  VON WAGNER Christian;  HERRMANN Benedikt; 

2022-01-28

ELSEVIER BV

JRC122264

2211-3355 (online),   

https://www.sciencedirect.com/science/article/pii/S2211335521001893?via%3Dihub,    https://publications.jrc.ec.europa.eu/repository/handle/JRC122264,   

10.1016/j.pmedr.2021.101499 (online),