Can a home-visit invitation increase Pap smear screening in Samliem, Khon Kaen, Thailand?

Our objective was to assess the efficiency of a home-visit invitation aimed to increase uptake of cervical cancer screening in women between 35 and 60 years of age. From May, 2006, we conducted a quasi-randomized trial to determine if an in-home education and invitation intervention would increase uptake of cervical cancer screening. We randomly recruited 304 women from the Samliem inner-city community, Khon Kaen, Northeast Thailand, and assigned participants to either the intervention or control zone. Baseline screening coverage interviews were then performed: 58 of 158 women in the intervention zone and 46 of 146 in the control zone were excluded from the study because of having had a Pap smear within 5 years, but these were included in the final analysis. First, 100 women in the intervention group were visited in their homes by one of the researchers, who provided culturally-sensitive health education that emphasized the need for screening. Four months later, post-intervention, screening-coverage interviews were again performed in both groups, in combination with the same health education for 100 women in the control group for a comparison. There was no difference in the baseline Pap smear screening-coverage rate in the intervention vs. control zones (36.7 vs. 31.5%, p=0.339). One hundred women in the intervention group completed the intervention interviews and after four months, 100 women in the intervention group and 100 in the control group also completed the post-intervention interviews. The increased screening-coverage rate in the intervention zone was similar to that of the control zone (43.6 vs. 34.9%, p=0.119); however, there was a borderline significant increase in the intervention zone compared with baseline (36.7 to 43.6%, p=0.070). Therefore, home visit education and invitation intervention produced only a nominal effect on increasing Pap smear coverage within a 4-month study period.