1564P - Limited participation in breast cancer screening among low-SES women: A matter of engagement or of health literacy?

Background

With over 2 million cases diagnosed annually, breast cancer is a leading cause of cancer-related disability and mortality worldwide. Despite global efforts to implement screening programs, uptake rates vary widely across settings due to socioeconomic factors and accessibility challenges. In 2022 in Flanders (Belgium), breast cancer screening participation in municipalities with income below the poverty line was 15% lower than average.

Methods

To tackle the limited participation of low-SES women in the breast cancer screening program in Flanders, a culturally sensitive approach was used to realize a tailored reminder letter.

33 women (of which 29 non-native Dutch speakers) aged 50-69 with low-SES were identified with the assistance of community organizations to conduct Focus Group Discussions (FGDs). Through a series of 4 FGDs and 3 rounds of Delphi-consultations involving sector experts, valuable insights were gathered.

Results

Analysis of the standard invitation letter employed in the program revealed several challenges related to readability and comprehension. These included the excessive length of the text, the use of complex vocabulary and grammar beyond an A2 level, the inclusion of contextual sentences unrelated to the mammography appointment (“We do it. And what do you do?”), and the use of generic visuals (eg. a picture of women).

At the same time, simplifying the vocabulary to A1-A2 levels (“cancer”, “doctor”, “appointment”, “check”, “free”), employing straightforward sentence structures, and incorporating relevant visuals (e.g. image of a mammography machine) enhanced understandability and fostered interest in breast cancer prevention. Additionally, utilizing a color palette associated with breast cancer and featuring logos of local authorities instilled a sense of credibility and trustworthiness.

Conclusions

Based on feedback from sector experts and insights from the FGDs, a revised reminder letter was developed. The final communication was concise and included essential details such as time and place for screening, as well as a QR code providing translation into 12 languages.

To assess its efficacy in increasing participation rates, a RCT with 3,430 participants per arm is currently being conducted.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Stichting tegen Kanker.

Disclosure

All authors have declared no conflicts of interest.