Adapting invitation letters to increase breast screening attendance

INTERVENTION: The intervention consists of adapting the invitation letter for routine breast cancer screening appointments sent to eligible women, registered at GP practices in the Greater Manchester area. Randomization: Women who are due to receive a letter will be randomly assigned to one of the three arms of the trial, based on the middle three digits of each invitees’ NHS number. This process will be undertaken by Synertec, the company in charge of printing and sending out the invitation letters on behalf of the screening centres. Women will receive either the standard invitation letters that is currently sent by the screening services or one of the two new behaviourally informed letters. The first intervention letter includes the cost to the NHS of missing a breast screening appointment and encourages women to let the screening service know if they cannot make their appointment. This is motivated by behavioural research showing that people are very sensitive to framing of particular outcome as a loss. In previous trials, including the cost of missed appointment to the NHS in text message reminders helped to significantly reduce non‐attendance. The second intervention letter includes a message which states the date that women from a particular GP practice are being booked appointments until. Behavioural research shows people are sensitive to the feeling of scarcity and limited time availability. Moreover, it has been shown that using a clear deadline helps solve procrastination and self‐control problems. The screening invitation contains all the relevant information about the appointment and of the three letters will be sent alongside the national breast screening leaflet which details the benefits and risks of breast screening, as well as any other information routinely send out by each of the screening services. CONDITION: Behavioural patient‐centered barriers ; Mental and Behavioural Disorders PRIMARY OUTCOME: The proportion of women who received appointment letters who go on to attend their appointments at the specified appointment date, time, and location, between when the trial commences and concludes. SECONDARY OUTCOME: The proportion of women who received appointment letters who go on to rearrange their appointments during the duration of trial INCLUSION CRITERIA: 1. Women 2. Aged between 50 and 70 3. Registered with a GP in the four above‐mentioned Greater Manchester areas 4. Who are due to be invited for a breast screening appointment during the period of the trial 5. The trial also includes some women who are 48 and 49 or over 70. This is because some women within this age range are currently being invited to breast screening appointments, as part of a separate nationwide trial that is being run to test the value for money of screening for these other age groups