Impact of messaging informed by behavioural science on uptake of targeted lung health checks: a service evaluation.

BACKGROUND: Lung cancer is the most common cause of cancer death in the UK, and incidence is strongly associated with increasing age. Screening can improve survival by detecting cancer earlier. Targeted Lung Health Check (TLHC) programme is a lung cancer screening pilot offered to smokers or ex-smokers aged 55-74 years in certain areas of England. However, uptake remains as low as 20% in London. We did a service evaluation to assess the effect of adding messaging informed by behaviour science to invitation letters on TLHC uptake. METHODS: The intervention involved adding to the standard invitation letter a box with a two-sentence behavioural message targeted at mitigating fatalistic beliefs and low risk perception, as well as promoting clinician endorsement and the value of early detection. Allocation to receive either standard or intervention letters was done at West London GP practice level, with approximate pairing between practices. From Sept 22, 2022, to Nov 28, 2022, 9464 invitations were sent to eligible individuals (4842 standard and 4622 intervention) covering 20 GP practices. The primary outcome (uptake) was a booked appointment date within 4 months of the invitation letter being sent. TIDieR checklist was used for methodology and reporting guidelines. We used χ2 analysis to test for significant differences in uptake, and mixed-effects logistic regression to control for demographic covariates. FINDINGS: Demographic characteristics were similar in the control and intervention groups, with mean ages of 63·3 and 63·0 years, average index of multiple deprivation (IMD) deciles of 6·33 and 5·53, and percentage of female participants 42·1% (n=2038) and 43·7% (n=2022), respectively. Uptake of TLHC was significantly higher in the intervention group (25·8%, n=1192) than in the control group (20·4%, n=987; χ2(1)=38·762, p<0·0001). A logistic regression model estimated likelihood of uptake was 37·5% (95% CI 12·1-63·2) higher in the intervention group (p=0·004). Patients aged 60-64, 65-69 and 70-75 years were 23·5% (10·7-36·3, p=0·0003), 28·3% (14·5-42·0, p<0·0001), and 32·6% (18·3-47·0, p<0·0001) more likely to attend than those aged 55-59 years. The likelihood of attendance decreased on the basis of deprivation (IMD decile; b=0·060, 95% CI 0·035-0·087, p<0·0001), female gender (b=0·156, 0·057-0·254, p=0·002), and for ex-smokers compared with smokers (b=0·580, 0·467-0·693, p<0·0001). INTERPRETATION: This simple, no-cost addition of behavioural messaging to invitation letters can significantly improve screening uptake and is recommended for wider rollout. These findings are consistent with other studies. However, a limitation is that the allocation to study arm was at GP practice level and the study was not randomised. FUNDING: RM Partners, the West London Cancer Alliance.

Detection of vaccine-derived poliovirus type 2 amid the burden of infectious diseases in the UK: A cause for alarm.

The re-emergence of polio in the UK reminds us that the global threat of polio remains. Viruses know no bounds or borders. COVID-19, Monkeypox, and polio are evidence of this. Poliomyelitis was once the leading cause of death and paralysis in the UK and globally. With the introduction of vaccines during the 1950s-1960s, polio was eradicated from most developed countries, including the UK. The last case of wild polio was in 1984, and the UK was polio-free in 2003. The recent detection of vaccine-derived poliovirus type 2 in London sewage samples is alarming. Routine inoculations were adversely affected due to COVID-19, and UK's wastewater monitoring program was suspended due to economic restrictions. The UK faces several challenges with the burden of COVID-19, Monkeypox, and the return of polio could further burden the already pandemic-stricken healthcare system. To prevent further epidemics in the UK, wastewater sampling remains crucial in evaluating, searching, and eradicating the spread of poliovirus. Further epidemiological surveillance in adjacent areas to the Beckton plant is crucial to filling any gaps in understanding the outbreak's extent and guiding the initiation of appropriate and timely public health measures. The importance of vaccination in unvaccinated or incompletely vaccinated individuals cannot be overstated, especially in areas where vaccination rates are low. The risk of polio remains globally until its complete eradication from endemic countries. Until elimination, a global effort should be made to minimize the risk and the consequent spread of poliovirus by maintaining strong population immunity levels through high vaccination coverage.