Increasing cervical cancer screening participation: a cluster-randomized pilot study at a department of gynaecology

BACKGROUND: Cervical cancer remains largely preventable with vaccination and screening, yet nearly 40% of eligible Danish women did not participate in screening in 2023—accounting for about 45% of annual cervical cancer cases. This pilot study evaluated whether integrating two interventions into routine outpatient gynaecology could improve screening uptake among under- and never-screened women. METHODS: In this cluster-randomized study, women aged 23–64 years were assigned to one of three groups: Intervention A (digital pamphlet encouraging to request cervical cancer screening (CCS) during their visit), Intervention B (verbal encouragement to CCS by a gynaecologist), or Control (standard care). The primary outcome was CCS uptake during the outpatient visit. Participant experiences were assessed through a structured post-visit questionnaire including both closed and open-ended questions. Exact logistic regression estimated odds ratios (OR), confidence intervals (CI), and p-values. RESULTS: Among 1810 participants, baseline screening uptake was 86.1%. Neither intervention significantly increased uptake compared to the Control Group: Intervention A (OR = 0.96, 95% CI 0.46–1.99; p = 0.917); Intervention B (OR = 0.99, 95% CI 0.51–1.89; p = 0.964). Among under-screened women, Intervention B showed a non-significant trend toward higher participation (OR = 1.20, 95% CI 0.57–2.50). Many participants expressed a strong preference for verbal encouragement and emphasized the value of being directly offered screening. CONCLUSION: Neither intervention significantly improved screening rates in a hospital-based population with high baseline uptake. However, patient insights suggest that personalized, proactive communication could help overcome barriers. Future research should test these strategies in community settings with lower baseline participation for broader applicability. TRIAL REGISTRATION: The Region of Southern Denmark register (Case no 24/30143) and Scientific Ethics Committee, Region of Southern Denmark (case no 20232000–119).