Forty-six studies, reporting 63 separate interventions, were included in the review (the total number of participants was not reported). Of these, 31 were randomised controlled trials.
Patient-targeted interventions (24 studies).
Most behavioural interventions increased Pap smear use compared with usual care or active controls. Cognitive, combined cognitive and behavioural, or sociological interventions were generally not effective. Two comprehensive interventions combining behavioural, cognitive and sociologic elements reported large effect sizes of 36.0 (95% CI: 25.1, 46.9) and 18.0 (95% CI: 7.6, 28.4), respectively.
Provider-targeted interventions (25 studies).
The results of the behavioural interventions showed considerable heterogeneity, with effect sizes ranging from an 18% decrease (95% CI: -29.2, -6.8) to a 44% increase (95% CI: 28.2, 59.8) in Pap smear use.
Amongst the cognitive interventions, slight increases in uptake were seen but these were statistically significant in only one study. The combined cognitive and behavioural interventions reported variable results.
Patient- and provider-targeted interventions (12 studies).
These interventions did not appear to be any more effective than interventions targeted to either patients or providers alone.
Health system interventions (2 studies).
One intervention involved the integration of a nurse practitioner and same-day screening. This led to a 32.7% (95% CI: 20.5, 44.9) increase in Pap smear use.