STRENGTHENING CERVICAL CANCER PREVENTION THROUGH BEHAVIORAL ECONOMICS INTERVENTIONS IN CLINICAL PRACTICE.
Cervical cancer is the third most common cancer among women worldwide, and it is ranked in the top five. Overall impact are high to both patients and national health expenditures. Primary and secondary prevention strategies are essential and must be well implemented at individual, societal, and health system levels. Behavioral economics is proposed to be integrated in clinical practice worldwide to optimize cervical screening practice as well as vaccination to prevent high-risk human papilloma viral infections. However, evidence-based interventions are still not well-documented for use in clinical setting and are needed for national policy formulation.
We conducted a state-of-the-art review of behavioral economics interventions in clinical practice from PubMed and Scopus databases from 1966-2019. Searching terms included cervical cancer, cervical carcinoma, behavioral economics, nudge, reward, and incentive, in order to identify relevant literature. The retrieved lists underwent screening by title and abstract, duplication checking, and full-text articles were obtained for analysis. Policy recommendations were synthesized through comparative analysis with national resolution from 11th National Health Assembly (NHA) in 2018.
106 articles were initially entered the screening processes and 23 articles were finally included in the analysis. Twelve articles (52.17%) were based on population in the US and Canada, 7 (30.43%) in Europe, 2 (8.7%) in Australia, 2 (8.7%) in Asia. Fifty percent of the interventions focused on providers, and the remaining targeted the population. Main behavioral economics interventions were designed as incentives (financial and non-financial), information provision/education (conventional, personalized, and gamified), and others (e.g. financial, human resources, services, and organizational management). 18 out of 23 articles pointed out positive effects whereas 4 showed no significant changes and 1 revealed negative effect. Performance measures and outcomes included knowledge, perceived self-efficacy, cervical cancer screening rate, immunization rate, etc. Three policy recommendations were formulated in accordance with 11th NHA resolution to put into clinical practice and health systems management.
Behavioral economics interventions have been proven to be effective in behavioral changes, not only for targeted population but also for healthcare professionals. To strengthen cervical cancer prevention such as pap smear and HPV vaccination, newer strategies should be considered to put into practice in clinical setting and societal level.