Cancer Screening: Interventions Engaging Community Health Workers Breast Cancer

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends interventions that engage community health workers to increase screening for breast cancer by mammography.

Evidence shows these interventions increase breast cancer screening rates when community health workers deliver them independently or as part of an implementation team.

Interventions that engage community health workers to increase breast cancer screening are typically implemented in underserved communities to improve health and can enhance health equity.

The CPSTF has related findings for interventions engaging community health workers to increase appropriate screening for the following:

Intervention

Interventions that engage community health workers (CHWs) to increase breast cancer screening implement one or more interventions reviewed by the CPSTF to do the following:

CHWs are trained frontline health workers who serve as a bridge between communities and healthcare systems. They are from, or have a close understanding of, the community served. They often receive on-the-job training and work without professional titles. Organizations may hire CHWs or recruit volunteers to act in this role. CHWs may work alone or as part of an intervention team that includes other healthcare professionals.

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

About The Systematic Review

The CPSTF recommendation is based on evidence from a systematic review of 66 studies (search period through July 2017). Included studies evaluated intervention effects on breast (36 studies), cervical (29 studies), or colorectal (17 studies) cancer screening use services recommended by the U.S. Preventive Services Task Force (2016a, 2018, 2016b, respectively).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 66 studies. Studies evaluated intervention effects on breast (36 studies), cervical (29 studies), or colorectal (17 studies) cancer screening use.

Breast Cancer Screening

  • Interventions that engaged community health workers, alone or as part of a team, increased breast cancer screening by a median of 12.7 percentage points when compared with no intervention or usual care (35 studies).

Breast, Cervical, or Colorectal Cancer Screening

The following results are based on an analysis of all included studies across breast, cervical, or colorectal cancer screening. Stratified analyses were performed for each cancer type and findings were comparable.

  • When compared to interventions that increase community demand or access alone, interventions that aimed to both increase community demand, and access to, screening services reported the largest increases in screening rates (median increase of 18.5 percentage points, 22 studies with 24 study arms).
  • Interventions engaged community health workers to implement between one and six intervention components.
    • While all of the studies reported increases in cancer screening, larger increases were seen when community health workers implemented more intervention components.
    • Interventions that provided group education produced larger increases in cancer screening (15.0 percentage points, 31 studies with 35 study arms) than those that provided one-on-one education (9.8 percentage points, 37 studies with 42 study arms).
    • Among studies that aimed to increase access to screening services, larger increases were reported when community health workers assisted with translation (30.2 percentage points, 4 studies with 4 study arms) or transportation barriers (26.8 percentage points, 9 studies with 9 study arms).
  • Lower baseline screening rates were associated with greater increases.

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review of economic evidence included five studies specific to breast cancer screening by mammography (search period through April 2019). Monetary values are reported in 2018 U.S. dollars.

  • There was not enough economic evidence to determine cost-effectiveness for interventions engaging CHWs to increase breast cancer screening because none of the included studies reported incremental cost per quality-adjusted life year gained.
  • The median cost per person was $1,578 for an intervention in the United Kingdom during which CHWs promoted cancer screening and helped clients manage chronic conditions, such as asthma and diabetes.
  • The median cost per person was $58 for CHW interventions in the United States (2 studies).
  • The median incremental cost per additional woman screened was $215 in the United States (1 study) and $7,891 in the United Kingdom (1 study of a comprehensive CHW intervention).

Applicability

Based on results from studies that assessed intervention effectiveness on breast, cervical, or colorectal cancer screening rates, findings should be applicable to a wide range of populations, across education and income levels, employment and insurance status, and race/ethnicity. Findings should be applicable to interventions set in healthcare systems or communities.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • What is the impact of these interventions on repeat screening?
  • Are these interventions effective among American Natives/Alaska Natives?
  • Is intervention effectiveness influenced by any of the following?
    • Participants’ health literacy
    • Supervision of community health workers
    • Compensation for community health workers
    • Inclusion of community health workers in research and evaluation
  • How does community health worker training affect outcomes? What is the best way to train them for this type of work?
  • Are these interventions cost-beneficial?

Study Characteristics

The following characteristics describe included studies across all three cancer types.

  • Studies were conducted in urban and rural areas of the United States (62 studies) and other high-income countries (8 studies).
  • Participants reported a mean age of 53 years and represented African American, Hispanic, Asian American, and white populations.

Analytic Framework

Effectiveness Review

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

The economic review team develops an analytic framework to align economic outcomes with each stage of the effectiveness review analytic framework. It informs the economic research questions and may be used to summarize the evidence for intervention cost, economic benefit, cost-effectiveness, and cost-benefit.

Summary Evidence Table

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

The following list of included studies is for interventions engaging community health workers to increase breast, cervical, or colorectal cancer screening.

Effectiveness Review

Ahmed NU, Haber G, Semenya KA, Hargreaves MK. Randomized controlled trial of mammography intervention in insured very low income women. Cancer Epidemiology and Prevention Biomarkers 2010;19(7):1790-8.

Aitaoto N, Braun KL, Estrella J, Epeluk A, Tsark J. Design and results of a culturally tailored cancer outreach project by and for Micronesian women. Preventing Chronic Disease 2012;9:E82.

Allen JD, P rez JE, Tom L, Leyva B, Diaz D, Torres MI. A pilot test of a church-based intervention to promote multiple cancer-screening behaviors among Latinas. Journal of Cancer Education 2014;29(1):136-43.

Allen Jr B, Bazargan-Hejazi S. Evaluating a tailored intervention to increase screening mammography in an urban area. Journal of the National Medical Association 2005;97(10):1350.

Bird JA, McPhee SJ, Ha N-T, Le B, Davis T, Jenkins CN. Opening pathways to cancer screening for Vietnamese-American women: lay health workers hold a key. Preventive Medicine 1998;27(6):821-9.

Braun KL, Thomas Jr WL, Domingo JLB, et al. Reducing cancer screening disparities in Medicare beneficiaries through cancer patient navigation. Journal of the American Geriatrics Society 2015;63(2):365-70.

Byrd TL, Wilson KM, Smith JL, et al. AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer 2013;119(7):1365-72.

Cardarelli K, Jackson R, Martin M, et al. Community-based participatory approach to reduce breast cancer disparities in south Dallas. Progress in Community Health Partnerships: Research, Education, and Action 2011;5(4):375-85.

Coronado GD, Beresford SA, McLerran D, et al. Multilevel intervention raises Latina participation in mammography screening: findings from Fortaleza Latina! Cancer Epidemiol Biomarkers Prev 2016;25(4):584-92.

Coronado GD, Golovaty I, Longton G, Levy L, Jimenez R. Effectiveness of a clinic-based colorectal cancer screening promotion program for underserved Hispanics. Cancer 2011;117(8):1745-54.

Dignan MB, Michielutte R, Wells HB, et al. Health education to increase screening for cervical cancer among Lumbee Indian women in North Carolina. Health Education Research 1998;13(4):545-56.

Dunn SF, Lofters AK, Ginsburg OM, et al. Cervical and breast cancer screening after CARES: a community program for immigrant and marginalized women. American Journal of Preventive Medicine 2017;52(5):589-97.

Earp JA, Eng E, O’Malley MS, et al. Increasing use of mammography among older, rural African American women: results from a community trial. American Journal of Public Health 2002;92(4):646-54.

Elder J, Haughton J, Perez L, et al. Promoting cancer screening among churchgoing Latinas: Fe en Accion/faith in action. Health Education Research 2017;32(2):163-73.

Elkin EB, Shapiro E, Snow JG, Zauber AG, Krauskopf MS. The economic impact of a patient navigator program to increase screening colonoscopy. Cancer 2012;118(23):5982-8.

Fang CY, Ma GX, Handorf EA, et al. Addressing multilevel barriers to cervical cancer screening in Korean American women: a randomized trial of a community-based intervention. Cancer 2017;123(6):1018-26.

Fern ndez ME, Gonzales A, Tortolero-Luna G, et al. Effectiveness of Cultivando la Salud: a breast and cervical cancer screening promotion program for low-income Hispanic women. American Journal of Public Health 2009;99(5):936-43.

Fiscella K, Humiston S, Hendren S, et al. A multimodal intervention to promote mammography and colorectal cancer screening in a safety-net practice. Journal of the National Medical Association 2011;103(8):762-8.

Fouad MN, Partridge E, Dignan M, et al. Targeted intervention strategies to increase and maintain mammography utilization among African American women. American Journal of Public Health 2010;100(12):2526-31.

Goelen G, De Clercq G, Hanssens S. A community peer-volunteer telephone reminder call to increase breast cancer-screening attendance. Oncology Nursing Forum 2010;37(4):E312-7.

Han H-R, Song Y, Kim M, et al. Breast and cervical cancer screening literacy among Korean American women: a community health worker led intervention. American Journal of Public Health 2017;107(1):159-65.

Hatcher J, Schoenberg N, Dignan M, Rayens M. Promoting mammography with African-American women in the emergency department using lay health workers. Journal of National Black Nurses’ Association 2016;27(1):38-44.

Hirst S, Mitchell H, Medley G. An evaluation of a campaign to increase cervical cancer screening in rural Victoria. Community Health Studies 1990;14(3):263-8.

Hoare T, Thomas C, Biggs A, Booth M, Bradley S, Friedman E. Can the uptake of breast screening by Asian women be increased? A randomized controlled trial of a linkworker intervention. Journal of Public Health 1994;16(2):179-85.

Holt C, Litaker M, Scarinci I, et al. Spiritually based intervention to increase colorectal cancer screening among African Americans: screening and theory-based outcomes from a randomized trial. Health Education & Behavior 2013;40(4):458-68.

Howze EH, Broyden RR, Impara JC. Using informal caregivers to communicate with women about mammography. Health Communication 1992;4(3):227-44.

Husaini BA, Emerson JS, Hull PC, Sherkat DE, Levine RS, Cain VA. Rural-urban differences in breast cancer screening among African American women. Journal of Health Care for the Poor and Underserved 2005;16(4):1-10.

Janz NK, Schottenfeld D, Doerr KM, et al. A two-step intervention of increase mammography among women aged 65 and older. American Journal of Public Health 1997;87(10):1683-6.

Jean-Jacques M, Kaleba EO, Gatta JL, Gracia G, Ryan ER, Choucair BN. Program to improve colorectal cancer screening in a low-income, racially diverse population: a randomized controlled trial. Annals of Family Medicine 2012;10(5):412-17.

Jo AM, Nguyen TT, Stewart S, et al. Lay health educators and print materials for the promotion of colorectal cancer screening among Korean Americans: a randomized comparative effectiveness study. Cancer 2017;123(14):2705-15.

Katz ML, Tatum C, Dickinson SL, et al. Improving colorectal cancer screening by using community volunteers: results of the Carolinas cancer education and screening (CARES) project. Cancer: Interdisciplinary International Journal of the American Cancer Society 2007;110(7):1602-10.

Lam TK, Mc Phee SJ, Mock J, et al. Encouraging Vietnamese-American women to obtain Pap tests through lay health worker outreach and media education. Journal of General Internal Medicine 2003;18(7):516-24.

Leone LA, Allicock M, Pignone MP, et al. Cluster randomized trial of a church-based peer counselor and tailored newsletter intervention to promote colorectal cancer screening and physical activity among older African Americans. Health Education & Behavior 2016;43(5):568-76.

Liu G, Perkins A. Using a lay cancer screening navigator to increase colorectal cancer screening rates. Journal of the American Board of Family Medicine 2015;28(2):280-2.

Livaudais JC, Coronado GD, Espinoza N, Islas I, Ibarra G, Thompson B. Educating Hispanic women about breast cancer prevention: evaluation of a home-based promotora-led intervention. Journal of Women’s Health 2010;19(11):2049-56.

Luque JS, Tarasenko YN, Reyes-Garcia C, et al. Salud es Vida: a cervical cancer screening intervention for rural Latina immigrant women. Journal of Cancer Education 2017;32(4):690-9.

Ma GX, Fang C, Tan Y, Feng Z, Ge S, Nguyen C. Increasing cervical cancer screening among Vietnamese Americans: a community-based intervention trial. Journal of Health Care for the Poor and Underserved 2015;26(2 Suppl):36.

Marshall JK, Mbah OM, Ford JG, et al. Effect of patient navigation on breast cancer screening among African American Medicare beneficiaries: a randomized controlled trial. Journal of General Internal Medicine 2016;31(1):68-76.

Mishra SI, Bastani R, Crespi CM, Chang LC, Luce PH, Baquet CR. Results of a randomized trial to increase mammogram usage among Samoan women. Cancer Epidemiology and Prevention Biomarkers 2007;16(12):2594-604.

Mock J, McPhee SJ, Nguyen T, et al. Effective lay health worker outreach and media-based education for promoting cervical cancer screening among Vietnamese American women. American Journal of Public Health 2007;97(9):1693-700.

Navarro AM, Senn KL, McNicholas LJ, Kaplan RM, Ropp B, Campo MC. Por La Vida model intervention enhances use of cancer screening tests among Latinas. American Journal of Preventive Medicine 1998;15(1):32-41.

Nguyen BH, Stewart SL, Nguyen TT, Bui-Tong N, McPhee SJ. Effectiveness of lay health worker outreach in reducing disparities in colorectal cancer screening in Vietnamese Americans. American Journal of Public Health 2015;105(10):2083-9.

Nguyen TT, McPhee SJ, Gildengorin G, et al. Papanicolaou testing among Vietnamese Americans: results of a multifaceted intervention. American Journal of Preventive Medicine 2006;31(1):1-9.

Nguyen TT, Le G, Nguyen T, et al. Breast cancer screening among Vietnamese Americans: a randomized controlled trial of lay health worker outreach. American Journal of Preventive Medicine 2009;37(4):306-13.

Nguyen TT, Tsoh JY, Woo K, et al. Colorectal cancer screening and Chinese Americans: efficacy of lay health worker outreach and print materials. American Journal of Preventive Medicine 2017;52(3):e67-76.

Nu o T, Martinez ME, Harris R, Garc a F. A promotora-administered group education intervention to promote breast and cervical cancer screening in a rural community along the US Mexico border: a randomized controlled trial. Cancer Causes & Control 2011;22(3):367-74.

O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. Journal of General Internal Medicine 2010;25(11):1186-92.

Paskett ED, Tatum CM, D’Agostino R, et al. Community-based interventions to improve breast and cervical cancer screening: results of the Forsyth County Cancer Screening (FoCaS) Project. Cancer Epidemiology and Prevention Biomarkers 1999;8(5):453-9.

Paskett E, Tatum C, Rushing J, et al. Randomized trial of an intervention to improve mammography utilization among a triracial rural population of women. Journal of the National Cancer Institute 2006;98(17):1226-37.

Paskett ED, McLaughlin JM, Lehman A, Katz ML, Tatum C, Oliveri JM. Evaluating the efficacy of lay health advisors for increasing risk-appropriate Pap test screening: a randomized controlled trial among Ohio Appalachian women. Cancer, Epidemiology, Biomarkers & Prevention 2011;20(5):835 43.

Percac-Lima S, Milosavljevic B, Oo SA, Marable D, Bond B. Patient navigation to improve breast cancer screening in Bosnian refugees and immigrants. Journal of Immigrant and Minority Health 2012;14(4):727-30.

Percac-Lima S, Ashburner JM, Bond B, Oo SA, Atlas SJ. Decreasing disparities in breast cancer screening in refugee women using culturally tailored patient navigation. Journal of General Internal Medicine 2013;28(11):1463-8.

Russell KM, Champion VL, Monahan PO, et al. Randomized trial of a lay health advisor and computer intervention to increase mammography screening in African American women. Cancer, Epidemiology, Biomarkers & Prevention 2010;19(1):201-10.

Sadler GR, Ko CM, Wu P, Alisangco J, Casta eda SF, Kelly C. A cluster randomized controlled trial to increase breast cancer screening among African American women: the black cosmetologists promoting health program. Journal of the National Medical Association 2011;103(8):735.

Sauaia A, Min S-j, Byers T, et al. Peer reviewed: church-based breast cancer screening education: impact of two approaches on Latinas enrolled in public and private health insurance plans. Preventing Chronic Disease 2007;4(4).

Studts CR, Tarasenko YN, Schoenberg NE, Shelton BJ, Hatcher-Keller J, Dignan MB. A community-based randomized trial of a faith-placed intervention to reduce cervical cancer burden in Appalachia. Preventive Medicine 2012;54(6):408-14.

Sung JF, Blumenthal DS, Coates RJ, Williams JE, Alema-Mensah E, Liff JM. Effect of a cancer screening intervention conducted by lay health workers among inner-city women. American Journal of Preventive Medicine 1997;13(1):51-7.

Taylor VM, Hislop TG, Jackson JC, et al. A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America. Journal of the National Cancer Institute 2002a;94(9):670-7.

Taylor VM, Jackson JC, Yasui Y, et al. Evaluation of an outreach intervention to promote cervical cancer screening among Cambodian American women. Cancer Detection and Prevention 2002b;26(4):320-7.

Taylor VM, Jackson JC, Yasui Y, et al. Evaluation of a cervical cancer control intervention using lay health workers for Vietnamese American women. American Journal of Public Health 2010;100(10):1924-9.

Thompson B, Carosso EA, Jhingan E, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer 2017;123(4):666-74.

Tong EK, Nguyen TT, Lo P, et al. Lay health educators increase colorectal cancer screening among Hmong Americans: a cluster randomized controlled trial. Cancer 2017;123(1):98-106.

Walsh JM, Salazar R, Nguyen TT, et al. Healthy colon, healthy life: a novel colorectal cancer screening intervention. American Journal of Preventive Medicine 2010;39(1):1-14.

Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. Journal of Women’s Health 2010;19(3):463-9.

Weinrich SP, Weinrich MC, Stromborg MF, Boyd MD, Weiss HL. Using elderly educators to increase colorectal cancer screening. Gerontologist 1993;33(4):491-6.

White K, Garces IC, Bandura L, McGuire AA, Scarinci IC. Design and evaluation of a theory-based, culturally relevant outreach model for breast and cervical cancer screening for Latina immigrants. Ethnicity & Disease 2012;22(3):274.

Economic Review

Hayhoe B, Cowling TE, Pillutla V, Garg P, Majeed A, Harris M. Integrating a nationally scaled workforce of community health workers in primary care: a modelling study. Journal of the Royal Society of Medicine 2018;111(12):453-61.

Lairson DR, Chang YC, Byrd TL, Smith JL, Fernandez ME, Wilson KM. Cervical cancer screening with AMIGAS: a cost-effectiveness analysis. American Journal of Preventive Medicine 2014;46(6):617-23.

Larkey LK, Herman PM, Roe DJ, Garcia F, Lopez AM, et al. A cancer screening intervention for underserved Latina women by lay educators. Journal of Women’s Health 2012;21(5):557-66.

Li Y, Carlson E, Villarreal R, Meraz L, Pag n JA. Cost-effectiveness of a patient navigation program to improve cervical cancer screening. American Journal of Managed Care 2017;23:429-34.

Mandelblatt JS, Schechter CB, Yabroff KR, Lawrence W, Dignam J, et al. Benefits and costs of interventions to improve breast cancer outcomes in African American women. Journal of Clinical Oncology 2004;22(13):2554-66.

Marshall JK, Mbah OM, Ford JG, Phelan-Emrick D, Ahmed S, et al. Effect of patient navigation on breast cancer screening among African American Medicare beneficiaries: a randomized controlled trial. Journal of General Internal Medicine 2016;31(1):68-76.

Meghea CI, Williams KP. Aligning cost assessment with community-based participatory research: The Kin KeeperSM Intervention. Health Education & Behavior 2015;42(2):148-52.

Schuster AL, Frick KD, Huh BY, Kim KB, Kim M, Han HR. Economic evaluation of a community health worker-led health literacy intervention to promote cancer screening among Korean American women. Journal of Health Care for the Poor and Underserved 2015;26(2):431.

Scoggins JF, Ramsey SD, Jackson JC, Taylor VM. Cost effectiveness of a program to promote screening for cervical cancer in the Vietnamese-American population. Asian Pacific Journal of Cancer Prevention 2010;11(3):717.

Stockdale SE, Keeler E, Duan N, Derose KP, Fox SA. Costs and cost-effectiveness of a church-based intervention to promote mammography screening. Health Services Research 2000;35(5 Pt 1):1037.

Thompson B, Carosso EA, Jhingan E, Wang L, Holte SE, et al. Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas. Cancer 2017;123(4):666-74.

Additional Materials

Implementation Product

  • Including Community Health Workers in Health Care Settings: A Checklist for Public Health Practitioners. This resource from CDC’s Division for Heart Disease and Stroke Prevention offers a general framework for public health practitioners who want to integrate a community health worker scope of practice in health care settings. The checklist is designed to be a conversation facilitator and can help to establish and strengthen relationships between community health workers and health care providers looking to address a range of health issues.

Search Strategies

The following outlines the search strategy for multicomponent interventions to increase breast, cervical, or colorectal cancer screening.

Effectiveness Review

The search for evidence included two steps.

  1. Researchers identified relevant publications from studies included in previous Community Guide systematic reviews of interventions to increase breast, cervical, or colorectal cancer screening (search period through 2013).
  2. A broad search for English-language papers that evaluated the impact of interventions engaging community health workers to increase breast, cervical, or colorectal cancer included the following databases PubMed, Medline, Embase, PsycINFO, Cochrane and CINAHL (search period: 2014 to July 2017). Search strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software.

The systematic review team combined publications identified through these two steps, and two team members independently screened each paper to determine eligibility. Uncertainties and disagreements were resolved by consensus among review team members.

Database: MEDLINE (OVID)
Saved Search Strategy Name: CommGuideCancerMCIFINAL

1. mass screening/ or multiphasic screening/ or (screen or screened or screening).ti,ab. or “early detection of cancer”/

2. (neoplasms/ or breast neoplasms/ or colorectal neoplasms/ or uterine cervical neoplasms/ or carcinoma, ductal, breast/ or “hereditary breast and ovarian cancer syndrome”/ or inflammatory breast neoplasms/ or colonic neoplasms/ or rectal neoplasms/) and (di or pc).fs.

3. ((adenoma* or neoplasia or cancer* or neoplasm* or tumo?r* or carcinoma* or adenocarcinoma*) and (breast or cervical or cervix or colon or colorectal or crc)).ti,ab.

4. 2 or 3

5. 1 and 4

6. colonography, computed tomographic/ or colonoscopy/ or endoscopy, gastrointestinal/ or sigmoidoscopy/ or ((occult blood.ti,ab. or occult blood/) and (feces/ or (faeces or fecal or faecal or colorectal).ti,ab.)) or (enema/ and barium sulfate/)

7. mammography/ or mammogra*.ti,ab.

8. (colonography or colonoscop* or fobt or sigmoidoscop*).ti,ab.

9. vaginal smears/ or (pap or papanicolaou).ti,ab.

10. 6 or 7 or 8 or 9

11. 5 or 10

12. health knowledge, attitudes, practice/ or “patient acceptance of health care”/ or patient compliance/ or patient participation/

13. health promotion/ or healthy people programs/ or health education/ or patient education as topic/ or persuasive communication/

14. (accept or acceptance or adherence or adhere* or compliance or compliant or health promotion or education or persuad* or persuasive or rescreen*).ti,ab.

15. reminder systems/ or “appointments and schedules”/

16. (prompt* or reminder*).ti,ab.

17. insurance/ or “cost sharing”/ or Financing, Personal/ or insurance benefits/ or insurance coverage/ or insurance, health/ or health benefit plans, employee/ or insurance, major medical/ or managed care programs/ or health maintenance organizations/ or medicare/ or Medicaid/

18. (cost or costs or costing or compensated or complimentary or copay* or co-pay* or cost assistance or coupon* or cover* or discount* or fee reduction* or financial assist* or free or indigen* or out-of-pocket or reduc* fee* or shared cost* or sharing cost* or subsidies or subsidis* or subsidiz* or subsidy or uncompensated or voucher* or employer-provided or low income).ti,ab.

19. (reduc* adj2 fee*).ti,ab.

20. “delivery of health care”/ or after-hours care/ or “delivery of health care, integrated”/ or health services accessibility/

21. (((Health care or healthcare or health services) adj3 access*) or onsite or “on-site” or after hours or (contract or contracted or contracts)).ti,ab. or contract services/

22. (insured or insurance or uninsured).ti,ab.

23. (health reform* or healthcare reform* or health care reform* or health policy or health policies or healthcare policy or healthcare policies or health care policy or health care policies).ti,ab. or Health Care Reform/ or Health Policy/

24. Quality Asurance, Health Care/ or clinical audit/ or medical audit/ or (public-health-improvement or continuous-quality-improvement).mp.

25. ((audit* adj2 (physician* or record or clinic*)) or quality assurance or incentive* or clinical audit).ti,ab. or Guideline Adherence/ or (incentive* or medical audit*).ti,ab. or Practice Guidelines as Topic/ or Predictive Value of Tests/ or (Quality or quality assurance).ti,ab. or quality assurance, healthcare/ or (quality audit or quality control or Quality Indicator*).ti,ab. or quality indicators, health care/ or Health Care/ or quality of health care/ or standards.hw. or quality improvement/ or (clinical quality or quality improvement).ti,ab.

26. Organizational Policy/ or ((organization* or institution*) adj2 (directive* or policies or policy or commitment)).ti,ab.

27. communications media/ or mass media/ or radio/ or television/ or internet/ or blogging/ or social media/ or video recording/ or telecommunications/ or electronic mail/ or blogging/ or text messaging/ or *computers/ or microcomputers/ or computers, handheld/ or computer-assisted instruction/

28. (television or radio or mass media or microcomputer*or cyberspace or “health 2.0” or avatar or wikipedia or weblog* or microblog* or “web 2.0” or listserv* or wiki* or “short message service” or sms or “mobile app” or iphone or ipad or ipod or “tablet computer” or xbox or x-box or nintendo or instagram or orkut or flickr or foursquare or video game* or computer game* or wii or ddr or advergram* or mobile phone* or cell phone* or handheld* or hand-held or web-based learning).ti,ab.

29. (internet or social media or world wide web or small media or advertis* or apps or app or automated voice or billboard* or blog or blogged or blogging or chat room* or commercial* or dvd or dvds or “dvd’s” or educational entertainment).ti,ab.

30. (email* or facebook or Googleplus or “google+” or Google plus or instagram or LinkedIn or myspace or toolkit* or edutainment or (“virtual reality” and (gaming or game*))).ti,ab.

31. (online or pinterest or pod cast* or podcast* or psa or psas or “psa’s” or public service announcement* or push* content or radio or Reddit or smart phone* or smartphone* or social network* or telephon* or television* or text messag* or instant messag* or social web or social website* or texting or texts or tumblr or tweet* or twitter or video* or vine or vlog* or video log or video blog or web page* or web site* or webinar* or website* or you tube or youtube).ti,ab.

32. (friending or wireless or “new media” or “new technolog*” or conversation* or messag* or video*).ti.

33. exp Community Health Workers/ or Patient Navigation/ or Community Health Centers/

34. (community health worker* or lay health worker* or consejera* or embajador* or group educat* or health advocat* or health educator* or link worker* or outreach worker* or outreach health or promotora* or patient navigat*).ti,ab.

35. ((Indigenous health* adj2 worker*) or link worker* or Peer-based health care team* or Peer-based healthcare team* or Allied health worker or community health center* or Community-based health worker or Lay health advisor* or Skilled health attendant* or wraparound or wrap around).ti,ab.

36. (access* adj5 health*).ti,ab. or beauty culture/ or occupational health services/ or (assessment* or beauty parlor or beauty salon or checklist* or cosmetologist or employee health clinic or expand* hour* or feedback or hair dressers or hair salon or incremental or interven* or law or laws or longer hour* or mobile or multicomponent or multilevel or multiphas* or occupational health clinic or occupational health service* or outreach or provider* or doctor* or nurse* or resident* or physician* or allied health or salon or saturday clinic* or schedul* or transportation or transported or transporting or week end clinic* or weekend clinic* or work place or work site or workplace or worksite).ti,ab.

37. or/12-36

38. 11 and 37

39. limit 38 to (english language and yr=”2013 -Current”)

40. limit 39 to humans

41. animals/

42. 39 not 41

43. 40 or 42

CommGuideCancerMCIPsycINFO

1. (mass screening or multiphasic screening or screen or screened or screening or “early detection of cancer”).mp.

2. ((neoplasm* or ductal breast carcinoma* or “hereditary breast and ovarian cancer syndrome”) and (diagnosis or prevention)).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]

3. ((adenoma* or neoplasia or cancer* or neoplasm* or tumo?r* or carcinoma* or adenocarcinoma*) and (breast or cervical or cervix or colon or colorectal or crc)).mp.

4. 2 or 3

5. 1 and 4

6. ((colonography or colonoscopy or gastrointestinal endoscopy or sigmoidoscopy or occult blood) and (feces or faeces or fecal or faecal or colorectal)).mp.

7. mammogra*.mp.

8. (colonography or colonoscop* or fobt or sigmoidoscop*).mp.

9. (vaginal smears or pap or papanicolaou).mp.

10. 6 or 7 or 8 or 9

11. 5 or 10

12. (health knowledge or health attitude* or health practice* or (patient acceptance adj2 health care) or (patient compliance or patient participation)).mp.

13. (health promotion or healthy people program* or health education or patient education or persuasive communication*).mp.

14. (accept or acceptance or adherence or adhere* or compliance or compliant or health promotion or education or persuad* or persuasive or rescreen*).mp.

15. (reminder system* or appointment* or schedul*).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]

16. (prompt* or reminder*).mp.

17. (insurance or “cost sharing” or personal financ* or insurance benefit* or insurance coverage or health insurance or health benefit plan* or employee or insurance or medical insurance or medical coverage or managed care program* or health maintenance organization* or medicare or Medicaid).mp.

18. (cost or costs or costing or compensated or complimentary or copay* or co-pay* or cost assistance or coupon* or cover* or discount* or fee reduction* or financial assist* or free or indigen* or out-of-pocket or reduc* fee* or shared cost* or sharing cost* or subsidies or subsidis* or subsidiz* or subsidy or uncompensated or voucher* or employer-provided or low income).mp.

19. (reduc* adj2 fee*).mp.

20. ((delivery adj2 health care) or after-hours care or health services accessibility).mp.

21. (((Health care or healthcare or health services) adj3 access*) or onsite or “on-site” or after hours or (contract or contracted or contracts) or contract* service*).mp.

22. (insured or insurance or uninsured).mp.

23. (health reform* or healthcare reform* or health care reform* or health policy or health policies or healthcare policy or healthcare policies or health care policy or health care policies or Health Care Reform* or Health Policy or health policies).mp.

24. ((Quality Asurance adj3 Health Care) or clinical audit or medical audit or (public-health-improvement or continuous-quality-improvement)).mp.

25. ((audit* adj2 (physician* or record or clinic*)) or (quality assurance or incentive* or clinical audit or Guideline Adherence or medical audit* or Practice Guideline*) or (Predictive Value adj2 Test*) or (quality or quality audit or quality control or Quality Indicator*) or (Health Care adj2 quality) or (standard* or quality improvement or clinical quality)).mp.

26. (Organizational Policy or organizational policies or ((organization* or institution*) adj2 (directive* or policies or policy or commitment))).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]

27. (communications media or mass media or radio or television or internet or blogging or social media or video recording or telecommunications or electronic mail or blogging or text messaging or computer* or microcomputer* computers or computer-assisted instruction).mp.

28. (television or radio or mass media or microcomputer*or cyberspace or “health 2.0” or avatar or wikipedia or weblog* or microblog* or “web 2.0” or listserv* or wiki* or “short message service” or sms or “mobile app” or iphone or ipad or ipod or “tablet computer” or xbox or x-box or nintendo or instagram or orkut or flickr or foursquare or video game* or computer game* or wii or ddr or advergam* or mobile phone* or cell phone* or handheld* or hand-held or web-based learning).mp.

29. (internet or social media or world wide web or small media or advertis* or apps or app or automated voice or billboard* or blog or blogged or blogging or chat room* or commercial* or dvd or dvds or “dvd’s” or educational entertainment).mp.

30. (email* or facebook or Googleplus or “google+” or Google plus or instagram or LinkedIn or myspace or toolkit* or edutainment or (“virtual reality” and (gaming or game*))).mp.

31. (online or pinterest or pod cast* or podcast* or psa or psas or “psa’s” or public service announcement* or push* content or radio or Reddit or smart phone* or smartphone* or social network* or telephon* or television* or text messag* or instant messag* or social web or social website* or texting or texts or tumblr or tweet* or twitter or video* or vine or vlog* or video log or video blog or web page* or web site* or webinar* or website* or you tube or youtube).mp.

32. (friending or wireless or “new media” or “new technolog*” or conversation* or messag* or video*).mp.

33. (Community Health Worker* or Patient Navigat*or Community Health Centers).mp.

34. (community health worker* or lay health worker* or consejera* or embajador* or group educat* or health advocat* or health educator* or link worker* or outreach worker* or outreach health or promotora* or patient navigat*).mp.

35. ((Indigenous health* adj2 worker*) or link worker* or Peer-based health care team* or Peer-based healthcare team* or Allied health worker or community health center* or Community-based health worker or Lay health advisor* or Skilled health attendant* or wraparound or wrap around).mp.

36. ((access* adj5 health*) or beauty culture or occupational health service* or (assessment* or beauty parlor or beauty salon* or hair salon* or checklist* or cosmetologist* or employee health clinic* or expand* hour* or feedback or hair dresser* or incremental or interven* or law or laws or longer hour* or mobile or multicomponent or multilevel or multiphas* or occupational health clinic or occupational health service* or outreach or provider* or doctor* or nurse* or resident* or physician* or allied health or salon or Saturday clinic* or schedul* or transportation or transported or transporting or week end clinic* or weekend clinic* or work place or work site or workplace or worksite)).mp.

37. or/12-36

38. 11 and 37

39. limit 38 to (english language and yr=”2013 -Current”)

CommGuideCancerScreeningMCIEmbase

1. (mass screening or multiphasic screening or screen or screened or screening or “early detection of cancer”).mp.

2. ((neoplasm* or ductal breast carcinoma* or “hereditary breast and ovarian cancer syndrome”) and (diagnosis or prevention)).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

3. ((adenoma* or neoplasia or cancer* or neoplasm* or tumo?r* or carcinoma* or adenocarcinoma*) and (breast or cervical or cervix or colon or colorectal or crc)).mp.

4. 2 or 3

5. 1 and 4

6. ((colonography or colonoscopy or gastrointestinal endoscopy or sigmoidoscopy or occult blood) and (feces or faeces or fecal or faecal or colorectal)).mp.

7. mammogra*.mp.

8. (colonography or colonoscop* or fobt or sigmoidoscop*).mp.

9. (vaginal smears or pap or papanicolaou).mp.

10. 6 or 7 or 8 or 9

11. 5 or 10

12. (health knowledge or health attitude* or health practice* or (patient acceptance adj2 health care) or (patient compliance or patient participation)).mp.

13. (health promotion or healthy people program* or health education or patient education or persuasive communication*).mp.

14. (accept or acceptance or adherence or adhere* or compliance or compliant or health promotion or education or persuad* or persuasive or rescreen*).mp.

15. (reminder system* or appointment* or schedul*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

16. (prompt* or reminder*).mp.

17. (insurance or “cost sharing” or personal financ* or insurance benefit* or insurance coverage or health insurance or health benefit plan* or employee or insurance or medical insurance or medical coverage or managed care program* or health maintenance organization* or Medicare or Medicaid).mp.

18. (cost or costs or costing or compensated or complimentary or copay* or co-pay* or cost assistance or coupon* or cover* or discount* or fee reduction* or financial assist* or free or indigen* or out-of-pocket or reduc* fee* or shared cost* or sharing cost* or subsidies or subsidis* or subsidiz* or subsidy or uncompensated or voucher* or employer-provided or low income).mp.

19. (reduc* adj2 fee*).mp.

20. ((delivery adj2 health care) or after-hours care or health services accessibility).mp.

21. (((Health care or healthcare or health services) adj3 access*) or onsite or “on-site” or after hours or (contract or contracted or contracts) or contract* service*).mp.

22. (insured or insurance or uninsured).mp.

23. (health reform* or healthcare reform* or health care reform* or health policy or health policies or healthcare policy or healthcare policies or health care policy or health care policies or Health Care Reform* or Health Policy or health policies).mp.

24. ((Quality Assurance adj3 Health Care) or clinical audit or medical audit or (public-health-improvement or continuous-quality-improvement)).mp.

25. ((audit* adj2 (physician* or record or clinic*)) or (quality assurance or incentive* or clinical audit or Guideline Adherence or medical audit* or Practice Guideline*) or (Predictive Value adj2 Test*) or (quality or quality audit or quality control or Quality Indicator*) or (Health Care adj2 quality) or (standard* or quality improvement or clinical quality)).mp.

26. (Organizational Policy or organizational policies or ((organization* or institution*) adj2 (directive* or policies or policy or commitment))).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

27. (communications media or mass media or radio or television or internet or blogging or social media or video recording or telecommunications or electronic mail or blogging or text messaging or computer* or microcomputer* computers or computer-assisted instruction).mp.

28. (television or radio or mass media or microcomputer*or cyberspace or “health 2.0” or avatar or wikipedia or weblog* or microblog* or “web 2.0” or listserv* or wiki* or “short message service” or sms or “mobile app” or iphone or ipad or ipod or “tablet computer” or xbox or x-box or nintendo or instagram or orkut or flickr or foursquare or video game* or computer game* or wii or ddr or advergam* or mobile phone* or cell phone* or handheld* or hand-held or web-based learning).mp.

29. (internet or social media or world wide web or small media or advertis* or apps or app or automated voice or billboard* or blog or blogged or blogging or chat room* or commercial* or dvd or dvds or “dvd’s” or educational entertainment).mp.

30. (email* or facebook or Googleplus or “google+” or Google plus or instagram or LinkedIn or myspace or toolkit* or edutainment or (“virtual reality” and (gaming or game*))).mp.

31. (online or pinterest or pod cast* or podcast* or psa or psas or “psa’s” or public service announcement* or push* content or radio or Reddit or smart phone* or smartphone* or social network* or telephon* or television* or text messag* or instant messag* or social web or social website* or texting or texts or tumblr or tweet* or twitter or video* or vine or vlog* or video log or video blog or web page* or web site* or webinar* or website* or you tube or youtube).mp.

32. (friending or wireless or “new media” or “new technolog*” or conversation* or messag* or video*).mp.

33. (Community Health Worker* or Patient Navigat*or Community Health Centers).mp.

34. (community health worker* or lay health worker* or consejera* or embajador* or group educat* or health advocat* or health educator* or link worker* or outreach worker* or outreach health or promotora* or patient navigat*).mp.

35. ((Indigenous health* adj2 worker*) or link worker* or Peer-based health care team* or Peer-based healthcare team* or Allied health worker or community health center* or Community-based health worker or Lay health advisor* or Skilled health attendant* or wraparound or wrap around).mp.

36. ((access* adj5 health*) or beauty culture or occupational health service* or (assessment* or beauty parlor or beauty salon* or hair salon* or checklist* or cosmetologist* or employee health clinic* or expand* hour* or feedback or hair dresser* or incremental or interven* or law or laws or longer hour* or mobile or multicomponent or multilevel or multiphas* or occupational health clinic or occupational health service* or outreach or provider* or doctor* or nurse* or resident* or physician* or allied health or salon or saturday clinic* or schedul* or transportation or transported or transporting or week end clinic* or weekend clinic* or work place or work site or workplace or worksite)).mp.

37. or/12-36

38. 11 and 37

39. limit 38 to (english language and yr=2013 “Current”)

40. Exp United Kingdom/ Or Exp United States/

41. Exp Canada/ Or Canada.Mp.

42. Exp Western Europe/ Or Exp Southern Europe/

43. Exp “Australia And New Zealand”/ Or Exp Australia/ Or Australia.Mp.

44. (Antigua Or Barbuda Or Andorra Or Aruba Or Austria Or Bahama* Or Bahrain* Or Barbados Or Belgium Or Belgian Or Bermuda Or Brunei Or Darussalam).Mp.

45. (Cayman Islands Or Channel Islands Or Chile Or Croatia Or Curacao Or Cyprus Or Czech Or Denmark Or Estonia Or Equatorial Guinea Or Faeroe Islands Or Finland Or France).Mp.

46. (French Polynesia Or Germany Or Greece Or Greenland Or Guam Or Hong Kong Or Iceland Or Ireland Or “Isle Of Man” Or Israel Or Italy Or Japan Or Korea Or Kuwait Or Latvia Or Luxembourg Or Liechtenstein Or Lithuania Or Macao Or Malta Or Monaco Or New Caledonia Or New Zealand).Mp.

47. (Northern Mariana* Or Norway Or Oman Or Poland Or Portugal Or Puerto Rico Or Qatar Or Russian Federation Or Russia* Or San Marino Or Saudi Arabia Or Singapore Or Sint Maarten Or Saint Marten Or Saint Martin Or Slovak Or Slovenia Or Spain Or Saint Kitts Or St Kitts Or Nevis Or Sweden Or Switzerland Or Trinidad Or Tobago).Mp.

48. ((Turks And Caicos) Or United Arab Emirates Or United Kingdom Or Wales Or England Or Scotland Or United States Or Uruguay Or Virgin Island*).Mp.

49. animals.mp. or animal/

50. animal experiment/

51. human/

52. (India Or Pakistan Or Bangladesh Or China Or Taiwan Or North Korea Or Indonesia Or Malaysia Or Burma Or Myanmar Or Thailand Or Vietnam Or Tibet Or Afghanistan Or Turkmenistan Or Kazakhstan Or Uzbekistan Or Mongolia Or Kazakhstan Or Philippines Or Borneo Or New Guinea Or Sri Lanka Or Yemen Or Syria Or Iraq Or Iran Or Romania Or Turkey).mp.

53. (Bulgaria Or Hungary Or Morocco Or Algeria Or Libya Or Egypt Or Sudan Or Ethiopia Or Chad Or Niger Or Mali Or Mauritania Or Western Sahara Or Senegal Or Sierra Leone Or Liberia Or Burkina Or Ghana Or Cote D’ivoire Or Togo Or Benin Or Nigeria Or Cameroon Or Gabon Or Central African Republic Or Uganda Or Kenya Or Tanzania Or Congo Or Angola Or Malawi Or Zambia Or Namibia Or Botswana Or Mozambique Or Madagascar Or South Africa*).mp.

54. (Mexico Or Guatemala Or Honduras Or San Salvador Or Costa Rica Or Belize Or Nicaragua Or Panama Or Colombia Or Venezuela Or Guyana Or Suriname Or French Guiana Or Brazil Or Ecuador Or Peru Or Bolivia Or Paraguay Or Argentina Or Cuba Or Jamaica Or Haiti Or Dominican Republic).mp.

55. or/40-48

56. or/49-50

57. or/52-54

58. 39 and 55

59. 39 not 57

60. 39 not 56

61. 39 and 51

62. 58 or 59 or 60 or 61

63. limit 62 to medline

64. 62 not 63

65. limit 64 to exclude medline journals

CommGuideCancerScreeningSabatinoCombinedHelenaOnnaleeStrategy08_08_2013 MEDLINE

1. (uptake*or outreach or intervention*).tw. or exp intervention studies/ or exp patient compliance/ or “patient acceptance of health care”.mp. or provider*.mp. or doctor*.mp. or nurse*.mp. or resident*.mp. or physician*.mp. or “allied health”.mp. or incentive*.mp. or law.mp. or laws.mp. or assessment*.mp. or feedback.mp. or checklist*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

2. ((cancer* or neoplasm* or tumor*) adj4 (control* or early detection or health promotion* or reminder* or recall* or incentive* or mass media or small media or pamphlet* or brochure* or education or translation service* or reduced co-pay* or reduced cost* or women* health service* or mobile or promotor* or health advisor* or patient navigator or communit*)).tw.

3. ((access* adj5 health) or (access* adj5 health) or expand* hour* or longer hour* or weekend clinic* or saturday clinic* or schedul* or transporting or transportation).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

4. (clinical-quality-improvement or quality-improvement or clinical-quality).mp.

5. or/1-4

6. limit 5 to (english language and humans and yr=”2013 -Current”)

7. exp uterine cervical neoplasms/pc or exp cervical intraepithelial neoplasia/pc or exp uterine cervical dysplasia/pc or exp breast neoplasms/pc or exp colorectal neoplasms/pc or exp colonic neoplasms/pc or exp neoplasms/pc

8. exp mammography/ or exp vaginal smears/ or exp colonoscopy/ or exp occult blood/ or clinical breast exam*.mp. or barium enema*.mp. or colonoscop*.mp. or endoscop*.mp. or pap* smear*.mp. or occult blood.mp. or vaginal smear*.mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

9. (repeat screening* or diagnostic imag*).mp.

10. exp mass screening/ut or exp preventive health services/ut

11. exp *skin neoplasms/ or exp *prostatic neoplasms/ or exp *bone neoplasms/

12. exp *biliary tract neoplasms/ or exp *esophageal neoplasms/ or exp *cecal neoplasms/ or exp *duodenal neoplasms/ or exp *ileal neoplasms/ or exp *jejunal neoplasms/ or exp *stomach neoplasms/ or exp *liver neoplasms/ or exp *pancreatic neoplasms/ or exp *peritoneal neoplasms/ or exp *eye neoplasms/ or exp *”head and neck neoplasms”/ or exp *hematologic neoplasms/ or exp *nervous system neoplasms/ or exp *hematologic neoplasms/ or exp *nervous system neoplasms/

13. exp *skin neoplasms/ or exp *splenic neoplasms/ or exp *thoracic neoplasms/

14. or/7-10

15. or/11-13

16. 6 and 14

17. 16 not 15

18. limit 17 to (english language and humans and yr=”2013 -Current”)

19. mass screening/ or multiphasic screening/ or (screen or screened or screening).ti,ab. or “early detection of cancer”/

20. (neoplasms/ or breast neoplasms/ or colorectal neoplasms/ or uterine cervical neoplasms/ or carcinoma, ductal, breast/ or “hereditary breast and ovarian cancer syndrome”/ or inflammatory breast neoplasms/ or colonic neoplasms/ or rectal neoplasms/) and (di or pc).fs.

21. ((adenoma* or neoplasia or cancer* or neoplasm* or tumo?r* or carcinoma* or adenocarcinoma*) and (breast or cervical or cervix or colon or colorectal or crc)).ti,ab.

22. 20 or 21

23. 19 and 22

24. colonography, computed tomographic/ or colonoscopy/ or endoscopy, gastrointestinal/ or sigmoidoscopy/ or ((occult blood.ti,ab. or occult blood/) and (feces/ or (faeces or fecal or faecal or colorectal).ti,ab.)) or (enema/ and barium sulfate/)

25. mammography/ or mammogra*.ti,ab.

26. (colonography or colonoscop* or fobt or sigmoidoscop*).ti,ab.

27. vaginal smears/ or (pap or papanicolaou).ti,ab.

28. 24 or 25 or 26 or 27

29. 23 or 28

30. health knowledge, attitudes, practice/ or “patient acceptance of health care”/ or patient compliance/ or patient participation/

31. health promotion/ or healthy people programs/ or health education/ or patient education as topic/ or persuasive communication/

32. (accept or acceptance or adherence or adhere* or compliance or compliant or health promotion or education or persuad* or persuasive or rescreen*).ti,ab.

33. reminder systems/ or “appointments and schedules”/

34. (prompt* or reminder*).ti,ab.

35. insurance/ or “cost sharing”/ or Financing, Personal/ or insurance benefits/ or insurance coverage/ or insurance, health/ or health benefit plans, employee/ or insurance, major medical/ or managed care programs/ or health maintenance organizations/ or medicare/ or Medicaid/

36. (cost or costs or costing or compensated or complimentary or copay* or co-pay* or cost assistance or coupon* or cover* or discount* or fee reduction* or financial assist* or free or indigen* or out-of-pocket or reduc* fee* or shared cost* or sharing cost* or subsidies or subsidis* or subsidiz* or subsidy or uncompensated or voucher* or employer-provided or low income).ti,ab.

37. (reduc* adj2 fee*).ti,ab.

38. “delivery of health care”/ or after-hours care/ or “delivery of health care, integrated”/ or health services accessibility/

39. (((Health care or healthcare or health services) adj3 access*) or onsite or “on-site” or after hours or (contract or contracted or contracts)).ti,ab. or contract services/

40. (insured or insurance or uninsured).ti,ab.

41. (health reform* or healthcare reform* or health care reform* or health policy or health policies or healthcare policy or healthcare policies or health care policy or health care policies).ti,ab. or Health Care Reform/ or Health Policy/

42. Quality Assurance, Health Care/ or clinical audit/ or medical audit/ or (public-health-improvement or continuous-quality-improvement).mp.

43. ((audit* adj2 (physician* or record or clinic*)) or quality assurance or incentive* or clinical audit).ti,ab. or Guideline Adherence/ or (incentive* or medical audit*).ti,ab. or Practice Guidelines as Topic/ or Predictive Value of Tests/ or (Quality or quality assurance).ti,ab. or quality assurance, healthcare/ or (quality audit or quality control or Quality Indicator*).ti,ab. or quality indicators, health care/ or Health Care/ or quality of health care/ or standards.hw. or quality improvement/ or (clinical quality or quality improvement).ti,ab.

44. Organizational Policy/ or ((organization* or institution*) adj2 (directive* or policies or policy or commitment)).ti,ab.

45. communications media/ or mass media/ or radio/ or television/ or internet/ or blogging/ or social media/ or video recording/ or telecommunications/ or electronic mail/ or blogging/ or text messaging/ or *computers/ or microcomputers/ or computers, handheld/ or computer-assisted instruction/

46. (television or radio or mass media or microcomputer*or cyberspace or “health 2.0” or avatar or wikipedia or weblog* or microblog* or “web 2.0” or listserv* or wiki* or “short message service” or sms or “mobile app” or iphone or ipad or ipod or “tablet computer” or xbox or x-box or nintendo or instagram or orkut or flickr or foursquare or video game* or computer game* or wii or ddr or advergam* or mobile phone* or cell phone* or handheld* or hand-held or web-based learning).ti,ab.

47. (internet or social media or world wide web or small media or advertis* or apps or app or automated voice or billboard* or blog or blogged or blogging or chat room* or commercial* or dvd or dvds or “dvd’s” or educational entertainment).ti,ab.

48. (email* or facebook or Googleplus or “google+” or Google plus or instagram or LinkedIn or myspace or toolkit* or edutainment or (“virtual reality” and (gaming or game*))).ti,ab.

49. (online or pinterest or pod cast* or podcast* or psa or psas or “psa’s” or public service announcement* or push* content or radio or Reddit or smart phone* or smartphone* or social network* or telephon* or television* or text messag* or instant messag* or social web or social website* or texting or texts or tumblr or tweet* or twitter or video* or vine or vlog* or video log or video blog or web page* or web site* or webinar* or website* or you tube or youtube).ti,ab.

50. (friending or wireless or “new media” or “new technolog*” or conversation* or messag* or video*).ti.

51. exp Community Health Workers/ or Patient Navigation/ or Community Health Centers/

52. (community health worker* or lay health worker* or consejera* or embajador* or group educat* or health advocat* or health educator* or link worker* or outreach worker* or outreach health or promotora* or patient navigat*).ti,ab.

53. ((Indigenous health* adj2 worker*) or link worker* or Peer-based health care team* or Peer-based healthcare team* or Allied health worker or community health center* or Community-based health worker or Lay health advisor* or Skilled health attendant* or wraparound or wrap around).ti,ab.

54. (access* adj5 health*).ti,ab. or beauty culture/ or occupational health services/ or (assessment* or beauty parlor or beauty salon or checklist* or cosmetologist or employee health clinic or expand* hour* or feedback or hair dressers or hair salon or incremental or interven* or law or laws or longer hour* or mobile or multicomponent or multilevel or multiphas* or occupational health clinic or occupational health service* or outreach or provider* or doctor* or nurse* or resident* or physician* or allied health or salon or saturday clinic* or schedul* or transportation or transported or transporting or week end clinic* or weekend clinic* or work place or work site or workplace or worksite).ti,ab.

55. or/30-54

56. 29 and 55

57. limit 56 to (english language and yr=”2013 -Current”)

CINAHL (EbscoHost)

S57 S55 AND S56

S56 Limiters – Published Date: 20130101-20171231; English Language

S55 S52 AND S53

S54 S52 AND S53

S53 Limiters – Published Date: 20130101-20171231; English Language

S52 S50 AND S51

S51 Limiters – Published Date: 20130101-20171231

S50 S18 OR S37 OR S49

S49 S11 AND S48

S48 S38 OR S39 OR S40 OR S41 OR S42 OR S43 OR S44 OR S45 OR S46 OR S47

S47 ((access* N5 health*) or beauty culture or occupational health service* or (assessment* or beauty parlor or beauty salon* or hair salon* or checklist* or cosmetologist* or employee health clinic* or expand* hour* or feedback or hair dresser* or incremental or interven* or law or laws or longer hour* or mobile or multicomponent or multilevel or multiphas* or occupational health clinic or occupational health service* or outreach or provider* or doctor* or nurse* or resident* or physician* or allied health or salon or saturday clinic* or schedul* or transportation or transported or transporting or week end clinic* or weekend clinic* or work place or work site or workplace or worksite))

S46 ((Indigenous health* Nj2 worker*) or link worker* or Peer-based health care team* or Peer-based healthcare team* or Allied health worker or community health center* or Community-based health worker or Lay health advisor* or Skilled health attendant* or wraparound or wrap around)

S45 (community health worker* or lay health worker* or consejera* or embajador* or group educat* or health advocat* or health educator* or link worker* or outreach worker* or outreach health or promotora* or patient navigat*)

S44 (Community Health Worker* or Patient Navigator* or health navigat* or Community Health Center*)

S43 (friending or wireless or “new media” or “new technolog*” or conversation* or messag* or video*)

S42 (online or pinterest or pod cast* or podcast* or psa or psas or “psa’s” or public service announcement* or push* content or radio or Reddit or smart phone* or smartphone* or social network* or telephon* or television* or text messag* or instant messag* or social web or social website* or texting or texts or tumblr or tweet* or twitter or video* or vine or vlog* or video log or video blog or web page* or web site* or webinar* or website* or you tube or youtube)

S41 (email* or facebook or Googleplus or “google+” or Google plus or instagram or LinkedIn or myspace or toolkit* or edutainment or (“virtual reality” and (gaming or game*)))

S40 (internet or social media or world wide web or small media or advertis* or apps or app or automated voice or billboard* or blog or blogged or blogging or chat room* or commercial* or dvd or dvds or “dvd’s” or educational entertainment)

S39 (television or radio or mass media or microcomputer*or cyberspace or “health 2.0” or avatar or wikipedia or weblog* or microblog* or “web 2.0” or listserv* or wiki* or “short message service” or sms or “mobile app” or iphone or ipad or ipod or “tablet computer” or xbox or x-box or nintendo or instagram or orkut or flickr or foursquare or video game* or computer game* or wii or ddr or advergam* or mobile phone* or cell phone* or handheld* or hand-held or web-based learning)

S38 (communications media or mass media or radio or television or internet or blogging or social media or video recording or telecommunications or electronic mail or blogging or text messaging or computer* or microcomputer* computers or computer-assisted instruction)

S37 S11 AND S36

S36 (S19 OR S20 OR S21 OR S22 OR S23 OR S24 OR S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34 OR S35)

S35 (organization* or institution*) N2 (directive* or policies or policy or commitment)

S34 Organizational Policy or organizational policies

S33 (standard* or quality improvement or clinical quality)

S32 Health Care quality or “quality of health care”

S31 (quality or quality audit or quality control or Quality Indicator*)

S30 “predictive value of tests” or “predictive value of testing”

S29 quality assurance or incentive* or clinical audit or Guideline Adherence or medical audit* or Practice Guideline*

S28 audit* and (physician* or record or clinic*)

S27 ((Quality Assurance and Health Care) or clinical audit or medical audit or (public-health-improvement or continuous-quality-improvement))

S26 (health reform* or healthcare reform* or health care reform* or health policy or health policies or healthcare policy or healthcare policies or health care policy or health care policies or Health Care Reform* or Health Policy or health policies)

S25 insured or insurance or uninsured

S24 onsite or “on-site” or after hours or contract or contracted or contracts or contract* service*

S23 (Health care or healthcare or health services) and access*

S22 ((delivery of health care) or after-hours care or health services accessibility or health care delivery or healthcare delivery)

S21 (reduc* fee*)

S20 (cost or costs or costing or compensated or complimentary or copay* or co-pay* or cost assistance or coupon* or cover* or discount* or fee reduction* or financial assist* or free or indigen* or out-of-pocket or reduc* fee* or shared cost* or sharing cost* or subsidies or subsidis* or subsidiz* or subsidy or uncompensated or voucher* or employer-provided or low income)

S19 (insurance or “cost sharing” or personal Financ* or insurance benefit* or insurance coverage or health insurance or health benefit plan* or employee or insurance or medical insurance or medical coverage or managed care program* or health maintenance organization* or medicare or Medicaid)

S18 S11 AND S17

S17 S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16

S16 (prompt* or reminder*)

S15 (reminder system* or appointment* or schedul*)

S14 (accept or acceptance or adherence or adhere* or compliance or compliant or health promotion or education or persuad* or persuasive or rescreen*)

S13 (health promotion or healthy people program* or health education or patient education or persuasive communication*)

S12 (health knowledge or health attitude* or health practice* or (patient acceptance adj2 health care) or (patient compliance or patient participation))

S11 S5 OR S10

S10 S6 OR S7 OR S8 OR S9

S9 (vaginal smears or pap or papanicolaou)

S8 (colonography or colonoscop* or fobt or sigmoidoscop*)

S7 mammogra*

S6 ((colonography or colonoscopy or gastrointestinal endoscopy or sigmoidoscopy or occult blood) and (feces or faeces or fecal or faecal or colorectal))

S5 S2 AND S4

S4 S1 OR S3

S3 ((adenoma* or neoplasia or cancer* or neoplasm* or tumor* or tumour* or carcinoma* or adenocarcinoma*) and (breast or cervical or cervix or colon or colorectal or crc))

S2 (mass screening or multiphasic screening or screen or screened or screening or “early detection of cancer”)

S1 ((neoplasm* or ductal breast carcinoma* or “hereditary breast and ovarian cancer syndrome”) and (diagnosis or prevention))

Database: COCHRANE
Saved Search Name: CommGuideCancerScreeningMCI

ID Search

#1 screen* or “early detection”:ti,ab,kw (Word variations have been searched)

#2 vaginal smears or pap or papanicolaou

#3 colonography or colonoscop* or fobt or sigmoidoscop* or mammogra*.

#4 ((colonography or colonoscopy or gastrointestinal endoscopy or sigmoidoscopy or occult blood) and (feces or faeces or fecal or faecal or colorectal))

#5 ((neoplasm* or ductal breast carcinoma* or “hereditary breast and ovarian cancer syndrome”) and (diagnosis or prevention))

#6 ((adenoma* or neoplasia or cancer* or neoplasm* or tumor* or tumour* or carcinoma* or adenocarcinoma*) and (breast or cervical or cervix or colon or colorectal or crc))

#7 #5 or #6

#8 #1 and #7

#9 #2 or #3 or #4 or #8

#10 reminder* or compliance or participation or knowledge or attitude* or practice* or accept* or adher* or persua* or rescreen* or prompt* or appointment* or schedul* or “after hours” or access*:ti,ab,kw in Trials (Word variations have been searched)

#11 reform* or policy or policies or reduced fee* or reducing fee* or reduce fee* or subsidi* or comptensat* or discount or fee or fees or medicaid or medicare or voucher* or coupon* or insurance or cost sharing or managed care or hmo or health maintenance or health benefit* or delivery or contract*:ti,ab,kw in Trials (Word variations have been searched)

#12 multicomponent or multilevel or multi level or multiphas* or outreach or provider or salon or saturday clinic* or after hours or weekend or week end or worksite:ti,ab,kw in Trials (Word variations have been searched)

#13 transport* or work place or work site* or salon or allied health or occupational health or outreach or checklist* or cosmetologist* or hairdresser* or hair dresser* or beauty parlor* or employee health or assessment* or beauty culture or community based or peer or peers or group educat* or link worker* or indigenous or health advocat* or promotora* or navigat* or lay health or community health:ti,ab,kw in Trials (Word variations have been searched)

#14 transport* or friend* or new media or new technology website* or youtube or you tube or email* or facebook or tweet* or twitter or edutainment:ti,ab,kw in Trials (Word variations have been searched)

#15 new technology or website* or blog or blogs or blogging or social media or mass media or radio or television or commercials or commitment or electronic or mass media or microcomputer* or wii or handheld* or hand held or phone* or telephon* or advergam* or app or rss or listserv*:ti,ab,kw in Trials (Word variations have been searched)

#16 automated or chat room* or myspace or computer*:ti,ab,kw in Trials (Word variations have been searched)

#17 #10 or #11 or #12 or #13 or #14 or #15 or #16

#18 #9 and #17

#19 2013 or 2014 or 2015 or 2016 or 2017

#20 #18 and #19

Database: PubMed

(((((Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR Nevis OR Sweden OR Switzerland OR “Trinidad” OR “Tobago” OR Turks OR Caicos) AND English[lang])) OR (“Russia”[Mesh] OR “Republic of Korea”[Mesh] OR “Slovakia”[Mesh] OR “Great Britain”[Mesh] OR “Saint Kitts and Nevis”[Mesh] OR “Netherlands Antilles”[Mesh] OR “Brunei”[Mesh] OR “Virgin Islands of the United States”[Mesh] OR “Trinidad and Tobago”[Mesh] OR Andorra[mesh] OR Antigua[mesh] OR Barbuda[mesh] OR Aruba[mesh] OR Australia[mesh] OR Austria[mesh] OR Bahamas[mesh] OR Bahrain[mesh] OR Barbados[mesh] OR Belgium[mesh] OR Bermuda[mesh] OR Brunei[mesh] OR Canada[mesh] OR “Channel Islands”[mesh] OR Chile[mesh] OR Croatia[mesh] OR Cyprus[mesh] OR “Czech Republic”[mesh] OR Denmark[mesh] OR Estonia[mesh] OR “Equatorial Guinea”[mesh] OR Finland[mesh] OR France[mesh] OR Germany[mesh] OR Greece[mesh] OR Greenland[mesh] OR Guam[mesh] OR “Hong Kong”[mesh] OR Iceland[mesh] OR Ireland[mesh] OR Israel[mesh] OR Italy[mesh] OR Japan[mesh] OR Korea[mesh] OR Kuwait[mesh] OR Latvia[mesh] OR Liechtenstein[mesh] OR Lithuania[mesh] OR Luxembourg[mesh] OR Macao[mesh] OR Malta[mesh] OR Monaco[mesh] OR Netherlands[mesh] OR “New Caledonia”[mesh] OR “New Zealand”[mesh] OR “Northern Ireland”[mesh] OR Norway[mesh] OR Oman[mesh] OR Poland[mesh] OR Portugal[mesh] OR “Puerto Rico”[mesh] OR Qatar[mesh] OR Russia[mesh] OR “San Marino”[mesh] OR “Saudi Arabia”[mesh] OR Singapore[mesh] OR Slovenia[mesh] OR Spain[mesh] OR Sweden[mesh] OR Switzerland[mesh] OR “United Arab Emirates”[mesh] OR England[mesh] OR Scotland[mesh] OR Wales[mesh] OR “United States”[mesh] OR Uruguay[mesh]))) AND ((((((((((((((((((((((((((((((((((((((((((((((((((((((((((“health knowledge, attitudes, practice”[mesh] OR “patient acceptance of health care”[mesh] OR “patient compliance”[mesh] OR “patient participation”[mesh] OR “health promotion”[mesh] OR “healthy people programs”[mesh] OR “health education”[mesh] OR “patient education as topic”[mesh] OR “persuasive communication”[mesh] OR “reminder systems”[mesh] OR “appointments and schedules”[mesh]))) OR (((((“accept”[title/abstract] OR “acceptance”[title/abstract] OR “adherence”[title/abstract] OR adhere*[title/abstract] OR “compliance”[title/abstract] OR “compliant”[title/abstract] OR “health promotion”[title/abstract] OR “education”[title/abstract] OR persuad*[title/abstract] OR “persuasive”[title/abstract] OR rescreen*[title/abstract] OR prompt*[title/abstract] OR reminder*[title/abstract]))) OR ((((“cost”[title/abstract] OR “costs”[title/abstract] OR “costing”[title/abstract] OR “compensated”[title/abstract])))) OR (((“free”[title/abstract] OR indigen*[title/abstract] OR “out-of-pocket”[title/abstract] OR reduc* AND fee*[title/abstract] OR shared cost*[title/abstract] OR “subsidies”[title/abstract] OR subsidis*[title/abstract] OR subsidiz*[title/abstract] OR “subsidy”[title/abstract] OR “uncompensated”[title/abstract] OR voucher*[title/abstract] OR “employer-provided”[title/abstract] OR “low income”[title/abstract] OR “low incomes”[title/abstract]))) OR ((((“onsite”[title/abstract] OR “on-site”[title/abstract] OR “after hours”[title/abstract] OR “contract”[title/abstract] OR “contracted”[title/abstract] OR “contracts”[title/abstract]))) OR (((“insured”[title/abstract] OR “uninsured”[title/abstract] OR “insurance”[title/abstract]))) OR ((((“health reform”[title/abstract] OR healthcare reform*[title/abstract] OR health care reform*[title/abstract] OR “health policy”[title/abstract] OR “health policies”[title/abstract] OR “healthcare policy”[title/abstract] OR “health care policy”[title/abstract] OR “healthcare policies”[title/abstract] OR “health care policies”[title/abstract] OR “health care reform”[mesh] OR “health policy”[mesh])))) OR ((((“quality assurance, health care”[mesh] OR “clinical audit”[mesh] OR “medical audit”[mesh] OR “public health improvement”[title/abstract] OR “continuous quality improvement”[title/abstract])))) OR ((((audit*[title/abstract]) AND (physician*[title/abstract] OR “record”[title/abstract] OR clinic*[title/abstract]))(((audit*[title/abstract]) AND (physician*[title/abstract] OR “record”[title/abstract] OR clinic*[title/abstract])))) OR ((((“quality assurance”[title/abstract] OR incentive*[title/abstract] OR “clinical audit”[title/abstract] OR “guideline adherence”[mesh] OR “medical audit”[title/abstract] OR “quality”[title/abstract] OR “quality assurance”[title/abstract])))) OR (((((“quality audit”[title/abstract] OR “quality control”[title/abstract] OR quality indicator*[title/abstract] OR “quality indicators, health care”[mesh] OR “health care”[mesh] OR “quality of health care”[mesh] OR “quality improvement”[mesh] OR standards OR “clinical quality”[title/abstract] OR “quality improvement”[title/abstract]))))) OR ((((reduc*[title/abstract] AND and fee*[title/abstract])))) OR (“organizational policy”[mesh]) OR ((((((organization*[title/abstract] OR institution*[title/abstract])) AND (directive*[title/abstract] OR “policy”[title/abstract] OR “policies”[title/abstract] OR “commitment”[title/abstract]))))) OR (((((“communications media”[mesh] OR “mass media”[mesh] OR “radio”[mesh] OR “television”[mesh] OR “internet”[mesh] OR “blogging”[mesh] OR “social media”[mesh] OR “video recording”[mesh] OR “telecommunications”[mesh] OR “electronic mail”[mesh] OR “text messaging”[mesh] OR “computers”[mesh] OR “microcomputers”[mesh] OR “computers, handheld”[mesh] OR “computer-assisted instruction”[mesh]))))) OR (((((“television”[title/abstract] OR “radio”[title/abstract] OR “mass media”[title/abstract] OR microcomputer*[title/abstract] OR “cyberspace”[title/abstract] OR “health 2.0″[title/abstract] OR “avatar”[title/abstract] OR “wikipedia”[title/abstract] OR weblog*[title/abstract] OR microblog*[title/abstract] OR “web 2.0″[title/abstract] OR listserv*[title/abstract] OR wiki*[title/abstract] OR “short message service”[title/abstract] OR “sms”[title/abstract] OR “mobile app”[title/abstract] OR “iphone”[title/abstract] OR “ipad”[title/abstract] OR “ipod”[title/abstract] OR podcast*[title/abstract] OR “tablet computer”[title/abstract] OR “tablet computers”[title/abstract] OR “tablet computing”[title/abstract] OR “xbox”[title/abstract] OR “x-box”[title/abstract] OR “nintendo”[title/abstract] OR “instagram”[title/abstract] OR “orkut”[title/abstract] OR “flickr”[title/abstract] OR “foursquare”[title/abstract] OR video gram*[title/abstract] OR computer* AND gam*[title/abstract] OR “wii”[title/abstract] OR “ddr”[title/abstract] OR advergram*[title/abstract] OR mobile phone*[title/abstract] OR cell phone*[title/abstract] OR handheld*[title/abstract] OR “hand-held”[title/abstract] OR “snapchat”[title/abstract] OR “web-based”[title/abstract]))))) OR ((“internet”[title/abstract] OR “social media”[title/abstract] OR “world wide web”[title/abstract] or “small media”[title/abstract] or advertis*[title/abstract] or “apps”[title/abstract] or “app”[title/abstract] or “automated voice”[title/abstract] OR billboard*[title/abstract] OR “blog”[title/abstract] OR “blogging”[title/abstract] OR “blogged”[title/abstract] OR “chat”[title/abstract] OR commercial*[title/abstract] OR “dvd”[title/abstract] OR “dvds”[title/abstract] OR “dvd’s”[title/abstract] OR “educational entertainment”[title/abstract] OR email*[title/abstract] OR “facebook”[title/abstract] OR “googleplus”[title/abstract] OR “google+”[title/abstract] OR “google plus”[title/abstract] OR “instagram”[title/abstract] OR “linkedin”[title/abstract] OR “myspace”[title/abstract] OR toolkit*[title/abstract] OR “edutainment”[title/abstract]))) OR (((((“internet”[title/abstract] OR “social media”[title/abstract] OR “world wide web”[title/abstract] OR “small media”[title/abstract] OR advertis*[title/abstract] OR “apps”[title/abstract] OR “app”[title/abstract] OR “automated voice”[title/abstract] OR billboard*[title/abstract] OR “blog”[title/abstract] OR “blogging”[title/abstract] OR “blogged”[title/abstract] OR “chat”[title/abstract] OR commercial*[title/abstract] OR “dvd”[title/abstract] OR “dvds”[title/abstract] OR “dvd’s”[title/abstract] OR “educational entertainment”[title/abstract] OR email*[title/abstract] OR “facebook”[title/abstract] OR “googleplus”[title/abstract] OR “google+”[title/abstract] OR “google plus”[title/abstract] OR “instagram”[title/abstract] OR “linkedin”[title/abstract] OR “myspace”[title/abstract] OR toolkit*[title/abstract] OR “edutainment”[title/abstract]))) OR ((“virtual reality”[title/abstract]) AND (game*[title/abstract] OR “gaming”[title/abstract]))) OR ((“online”[title/abstract] OR “pinterest”[title/abstract] OR pod cast*[title/abstract] OR podcast*[title/abstract] OR “psa”[title/abstract] OR “psas”[title/abstract] OR “psa’s”[title/abstract] OR public service announcement*[title/abstract] OR “push content”[title/abstract] OR “pushing content”[title/abstract] OR “pushed content”[title/abstract] OR “radio”[title/abstract] OR “reddit”[title/abstract] OR smart phone*[title/abstract] OR smartphone*[title/abstract] OR social network*[title/abstract] OR telephon* AND title/abstract OR television*[title/abstract] OR text messag*[title/abstract] OR instant messag*[title/abstract] OR “social web”[title/abstract] OR social website*[title/abstract] OR “texting”[title/abstract] OR “texts”[title/abstract] OR “text”[title/abstract] OR “tumblr”[title/abstract] OR tweet*[title/abstract] OR “twitter”[title/abstract] OR video*[title/abstract] OR video*[title/abstract] OR “vine”[title/abstract] OR vlog*[title/abstract] OR “video log”[title/abstract] OR “video blog”[title/abstract] OR web page*[title/abstract] OR web site*[title/abstract] OR “you tube”[title/abstract] OR “youtube”[title/abstract]))) OR ((“friending”[title/abstract] OR “wireless”[title/abstract] OR “new media”[title/abstract] OR new techolog* AND title/abstract OR conversation*[title/abstract] OR messag*[title/abstract] OR video*[title/abstract]))) OR ((“community health workers”[mesh] OR “patient navigation”[mesh] OR “community health centers”[mesh]))) OR ((community health worker*[title/abstract] OR lay health worker*[title/abstract] OR consejera*[title/abstract] OR embajador*[title/abstract] OR group educat*[title/abstract] OR health advocat*[title/abstract] OR health educator*[title/abstract] OR link worker*[title/abstract] OR outreach worker*[title/abstract] OR “outreach health”[title/abstract] OR promotora*[title/abstract] OR patient navigat*[title/abstract]))) OR “health outreach”[title/abstract]) OR program*[Title]) OR ((“indigenous health”[title/abstract]) AND worker*[title/abstract])) OR ((“peer-based health care team”[title/abstract] OR “peer-based health care teams”[title/abstract] OR “peer-based healthcare team”[title/abstract] OR “peer-based healthcare teams”[title/abstract] OR allied health worker*[title/abstract] OR community health center*[title/abstract] OR community-based health worker*[title/abstract] OR lay health advisor*[title/abstract] OR skilled health attendant*[title/abstract] OR “wraparound”[title/abstract] OR “wrap around”[title/abstract]))) OR ((access*[title/abstract]) AND health*[title/abstract])) OR ((“beauty culture”[mesh] OR “occupational health services”[mesh] OR assessment*[title/abstract] OR beauty parlor*[title/abstract] OR beauty salon*[title/abstract] OR checklist*[title/abstract] OR cosmetologist*[title/abstract] OR employee health clinic*[title/abstract] OR expand* AND hours[title/abstract] OR “feedback”[title/abstract] OR hair dresser*[title/abstract] OR hair salon*[title/abstract] OR “incremental”[title/abstract] OR interven*[title/abstract] OR “law”[title/abstract] OR “laws”[title/abstract] OR “longer hours”[title/abstract] OR “mobile”[title/abstract] OR “multicomponent”[title/abstract] OR “multilevel”[title/abstract] OR multiphas*[title/abstract]))) OR ((occupational health clinic*[title/abstract] OR occupational health service*[title/abstract] OR “outreach”[title/abstract] OR provider*[title/abstract] OR doctor*[title/abstract] OR nurse*[title/abstract] OR resident*[title/abstract] OR physician*[title/abstract] OR “allied health”[title/abstract] OR “salon”[title/abstract] OR “salons”[title/abstract] OR saturday clinic*[title/abstract] OR schedul*[title/abstract] OR “transportation”[title/abstract] OR “transported”[title/abstract] OR “transporting”[title/abstract] OR week end clinic*[title/abstract] OR weekend clinic*[title/abstract] OR work place*[title/abstract] OR work site*[title/abstract] OR workplace*[title/abstract] OR worksite*[title/abstract]))))))) AND ( “2013/01/01″[PDat] : “2017/12/31″[PDat] ))) AND ((((((((“neoplasms”[mesh] OR “breast neoplasms”[mesh] OR “colorectal neoplasms”[mesh] OR “uterine cervical neoplasms”[mesh] OR “carcinoma, ductal, breast”[mesh] OR “hereditary breast and ovarian cancer syndrome”[mesh] OR “inflammatory breast neoplasms”[mesh] OR “colonic neoplasms”[mesh] OR “rectal neoplasms”[mesh]))) AND ( “2013/01/01″[PDat] : “2017/12/31″[PDat] ) AND English[lang])) AND ((((( (“mass screening”[mesh] OR “multiphasic screening”[mesh] OR “early detection of cancer”[mesh])))) OR ((“screening”[title/abstract] OR “screenings”[title/abstract] OR “screen”[title/abstract] OR “screens”[title/abstract]or “screened”[title/abstract]))) AND ( “2013/01/01″[PDat] : “2017/12/31″[PDat] ) AND English[lang]))) OR ((“colorectal”[title/abstract] OR “crc”[title/abstract] OR “colonography”[title/abstract] OR “colonoscopies”[title/abstract] OR “colonoscopy”[title/abstract] OR “fobt”[title/abstract] OR “sigmoidoscopy”[title/abstract] OR “vaginal smears”[mesh] OR “pap”[title/abstract] OR “papanicolaou”[title/abstract]) or ((“occult blood”[title/abstract] OR “occult blood”[mesh]) AND (“feces”[mesh] OR “faeces”[title/abstract] OR “fecal”[title/abstract] OR “faecal”[title/abstract])) AND ((“2013/01/01″[PDAT] : “2017/12/31″[PDAT]) AND English[lang])))) AND ( “2013/01/01″[PDat] : “2017/12/31″[PDat] ))

Economic Review

The review team conducted a search for economic evidence (search period through April 2019) using the following databases: PubMed, Medline, Embase, CINAHL, PsycINFO, Cochrane Library, and EconLit. To be included in the review, studies had to meet the following criteria:

  • Studies had to be written in English and conducted in a high-income economy (identified by the World Bank).
  • Studies had to evaluate screening outcomes recommended by USPSTF (breast, cervical and colorectal cancer screenings)
  • Outcomes could include recent or repeat screenings
  • Studies had to contain at least one of the following: cost(s), economic benefit(s), cost-benefit, cost-effectiveness

Considerations for Implementation

The following considerations for implementation are drawn from studies included in the evidence review, the broader literature, and expert opinion. They apply to interventions engaging community health workers to increase breast, cervical, or colorectal cancer screening.

  • While these interventions were effective across a wide range of settings and population groups, greater increases in screening were seen in the included studies when
    • More than two components were used
    • Components increased both demand for, and access to, screening services
    • Group education was offered instead of one-on-one education
  • Interventions that engage community health workers were effective across all population groups examined and can be modified for specific populations.
    • Interventions can be modified to target population groups experiencing screening disparities, usually minority groups, or groups with low income or no insurance
    • Reducing structural barriers may be especially effective. Programs may want to consider
      • Providing language translation services to largely non-English speaking populations
      • Offering transportation services to populations without ready access to healthcare services

Crosswalks

Healthy People 2030

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.