Condition category
Mental and Behavioural Disorders
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status
No longer recruiting
Publication status
Results overdue

Plain English Summary

Background and study aims
Breast cancer is one of the most common types of cancer in the UK. The earlier the cancer is caught, the better the chance of recovery. It is very important for women to check their breasts regularly and go to breast screening appointments. The average breast screening attendance rate across England is 75.4%, while Greater Manchester’s screening rate is below this national average at 61.6%. In this context, NHS Manchester would like to increase the breast screening rate within Greater Manchester
Letters are usually sent to women to invite them to prebooked breast screening appointments, and these letters could be adapted to help more women attend these appointments. This study aims to test whether it is possible to increase attendance rates for breast screening by adapting the invitation letters sent to eligible women.

Who can participate?
Women aged between 50 to 70 who are due to be invited for a breast screening appointment

What does the study involve?
Participants are randomly allocated to one of three groups. Those in the first group receive the standard invitation letter (already routinely sent out by the screening centres). Those in the second group receive a simplified invitation letter with a tear off slip and a message stating the cost to the NHS of missing the appointment. Those in the last group receive a simplified letter with a tear off slip and a behaviourally informed deadline message. All participants receive the national breast screening leaflet that outlines the benefits and risks of breast screening. Attendance rates are used to see whether those who received the adapted letters were more likely to attend their breast screening appointments and compare this to those who received the standard letter.

What are the possible benefits and risks of participating?
There are no notable benefits and risks with participating.

Where is the study run from?
This study is being run by the Behavioural Insights Team in collaboration with the Greater Manchester Health & Social Care Partnership (UK) and takes place in four breast screening centres which cover Greater Manchester area (UK).

When is the study starting and how long is it expected to run for?
August 2016 to June 2017

Who is funding the study?
Greater Manchester Health & Social Care Partnership (UK)

Who is the main contact?
Ms Isabelle Andresen

Trial website

Contact information



Primary contact

Ms Isabelle Andresen


Contact details

The Behavioural Insights Team
4 Matthew Parker Street
United Kingdom



Additional contact

Mr Michael Sanders


Contact details

The Behavioural Insights Team
4 Matthew Parker Street
United Kingdom

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Behaviorally informed invitation letters potential to increase breast screening attendance


Study hypothesis

The purpose of trial is to address behavioural patient-centred barriers to breast screening uptake – such as insufficient knowledge about the test, underestimation of the risk of developing cancer, inertia and forgetfulness, or negative feelings associated with the test (fear of pain, of embarrassment, of positive results, etc.).

The key assumption is that a behaviourally- informed invitation letter, compared to standard letters, could increase attendance of routine breast screening appointments. Crucially, the proposed intervention does not interfere with women being able to make free informed choice of whether or not to get screened; it only aims to facilitate the attendance for those who already wish to do so, by removing behavioral obstacles.

Ethics approval

East Midlands Nottingham 1, ref: 16/EM/0413

Study design

Multi-centre three-arm randomised controlled trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting

GP practices

Trial type


Patient information sheet

No participant information sheet available.


Behavioural patient-centered barriers


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.

Intervention type



Drug names

Primary outcome measure

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 measures

The proportion of women who received appointment letters who go on to rearrange their appointments during the duration of trial

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant 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

Participant type


Age group




Target number of participants


Participant exclusion criteria

1. Women registered with a GP outside of one of the four Greater Manchester areas
2. Women in GM who are not due to be screened during the period of the trial or not registered with a GP practice
3. Women under 50 years old or over 70 (with the above-mentioned exception of those included within the other NHS trial to test age ranges)
4. Women already diagnosed with cancer and are currently undergoing treatment

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

East Cheshire Trust
Victoria Rd
SK10 3BL
United Kingdom

Trial participating centre

University Hospital of South Manchester
Southmoor Rd
M23 9LT

Trial participating centre

Withington, Wigan, and Leigh Foundation Trust
Wigan Lane
United Kingdom

Trial participating centre

Royal Bolton Foundation Trust
Minerva Road
United Kingdom

Sponsor information


Greater Manchester Health & Social Care Partnership

Sponsor details

4th Floor
Three Piccadilly Place
M1 3BN
United Kingdom

Sponsor type




Funder type


Funder name

Greater Manchester Health & Social Care Partnership

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Results will be first summarized in a Internal Report. Eventually, these will be further disseminated via Conference Presentation, Publication on Website, Peer reviewed scientific journals.

Intention to publish date


Participant level data

Stored in repository

Basic results (scientific)

Publication list

Publication citations

Additional files

Editorial Notes

06/06/2017: Plain English summary added. 10/04/2017: Internal review.