Direct mail from primary care and targeted recruitment strategies achieved a representative uptake of prostate cancer screening

Abstract

Background and objectives: Prostate cancer screening studies has previously not been able to reflect a diverse group of participants. We evaluated a range of recruitment strategies and their ability to recruit from the Black population and areas of deprivation.

Methods: IP1-PROSTAGRAM was a prospective, population-based, paired screening study of 408 participants conducted at seven UK primary care practices and two imaging centres. All participants underwent screening with a prostate specific antigen (PSA) test, magnetic resonance imaging (MRI), and transrectal ultrasound. A number of recruitment strategies were embedded including direct mail, media campaigns, and a targeted recruitment strategy to increase participation among harder-to-reach groups.

Results: A total of 1,316 expressions of interest were received (20th September 2018 to 15th May 2019). The direct mail strategy generated 317 expressions of interest from 1707 invitation letters. Overall 387 expressions of interest were received following the targeted strategy and 612 from media campaigns. The recruitment target was met 19 months ahead of the schedule. Of the 411 participants, ethnicity was White (38.0%), Black (32.4%), Asian (23.0%), and Other/Mixed (4.4%) ethnic groups. This higher recruitment of Black men was driven by the targeted recruitment strategy. A comparison of recruitment methods showed marked differences between ethnicities recruited (P < 0.001). The proportion of Black participants recruited by direct mail (8%) was similar to the prevalence of Black local population (9%) whereas, targeted recruitment was 88% (115) and media recruitment 1.7% (1). The Index of Multiple Deprivation (IMD) distribution was similar to the local population with marginal higher recruitment from more deprived areas; proportion increasing from 26% to 40% from least to most deprived IMD quintiles (Quintiles 4/5 vs. 1/2). Direct mail recruited a close-to-normal distribution for deprivation with targeted recruitment trending towards recruiting from most deprived areas.

Conclusion: Direct mail and targeted strategies designed to engage a diverse population can achieve a representative uptake from Black participants and those from a lower socioeconomic group.

Keywords: MRI; PSA; Prostate cancer; Recruitment strategy; Screening; Socio-economic diversity.