You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Effects of an educational intervention based on the protection motivation theory and implementation intentions on first and second pap test practice in Iran.
Abstract 1:
BACKGROUND Few Iranian women take the Papanicolaou test despite its important role in preventing cervical cancer . This study aim ed to determine the effectiveness of an educational intervention based on the protection motivation theory ( PMT ) variables and implementation intentions in the first and second Pap test practice among Iranian women . MATERIAL S AND METHODS In this quasi-r and omized controlled trial , 200 women who were referred to 30 primary health care clinics in Tehran were r and omly selected .  PMT variables and Pap test practice  were measured at baseline and again after 3 and 15 months . The 4-week educational intervention program was conducted for the intervention group . RESULTS Following the intervention , the mean scores of self-efficacy , perceived vulnerability , and behavior intention variables were significantly higher in the intervention group when compared to the control group ( p<0.05 ) . No significant differences were found in the perceived severity , response efficacy , response cost , and fear between the two groups following the intervention . Higher percent of women in the intervention group had obtained first and second Pap test compared to the controls . CONCLUSIONS The PMT and implementation intentions provide a suitable theory-based framework for developing educational interventions regarding Pap test practice in Iran


Title 2:
Impact of health education intervention on knowledge and perception of cervical cancer and cervical screening uptake among adult women in rural communities in Nigeria
Abstract 2:
Background Cervical cancer is a disease of public health importance affecting many women and contributing to avoidably high levels of cancer deaths in Nigeria . In spite of the relative ease of prevention , the incidence is on the increase . This study aim ed to determine the effect of health education on the awareness , knowledge and perception of cervical cancer and screening among women in rural Nigerian communities . Methods The study design was quasi-experimental . The study was carried out among adult women in Odogbolu ( intervention ) and Ikenne ( control ) local government areas ( LGA ) of Ogun state . Three hundred and fifty ( 350 ) women were selected per group by multistage r and om sampling technique . Data was collected by semi structured interviews with the aid of question naire . The intervention consisted of structured health education based on a movie . Result The intervention raised the level of awareness of cervical cancer and screening to 100 % ( p < 0.0001 ) . The proportion of women with very good knowledge of cervical cancer and screening rose from 2 % to 70.5 % ( χ2 = 503.7 , p < 0.0001 ) while the proportion of those with good perception rose from 5.1 % to 95.1 % ( p < 0.0001 ) . The mean knowledge and mean perception scores were also increased ( p < 0.0001 ) . There was increase in the proportion of women who had undertaken cervical screening from 4.3 % to 8.3 % ( p = 0.038 ) . The major reason stated by the women for not having had cervical screening done was lack of awareness about cervical cancer and screening . There was statistically significant difference between the intervention and control groups concerning their knowledge attitude and practice towards cervical and screening ( p < 0.05 ) after the intervention . Conclusion Multiple media health education based on a movie is effective in creating awareness for and improving the knowledge and perception of adult women about cervical cancer and screening . It also improves the uptake of cervical cancer screening . The creation of awareness is very crucial to the success of a cervical cancer prevention programme


Title 3:
Evaluating the Efficacy of Lay Health Advisors for Increasing Risk-Appropriate Pap Test Screening: A Randomized Controlled Trial among Ohio Appalachian Women
Abstract 3:
Background : Cervical cancer is a significant health disparity among women in Ohio Appalachia . The goal of this study was to evaluate the efficacy of a lay health advisor ( LHA ) intervention for improving Papanicolaou ( Pap ) testing rates , to reduce cervical cancer , among women in need of screening . Methods : Women from 14 Ohio Appalachian clinics in need of a Pap test were r and omized to receive either usual care or an LHA intervention over a 10-month period . The intervention consisted of two in-person visits with an LHA , two phone calls , and four postcards . Both self-report and medical record review ( MRR ) data ( primary outcome ) were analyzed . Results : Of the 286 women , 145 and 141 were r and omized to intervention and usual care arms , respectively . According to MRR , more women in the LHA arm had a Pap test by the end of the study compared with those r and omized to usual care ( 51.1 % vs. 42.0 % ; OR = 1.44 , 95 % CI : 0.89–2.33 ; P = 0.135 ) . Results of self-report were more pronounced ( 71.3 % vs. 54.2 % ; OR = 2.10 , 95 % CI : 1.22–3.61 ; P = 0.008 ) . Conclusions : An LHA intervention showed some improvement in the receipt of Pap tests among Ohio Appalachian women in need of screening . Although biases inherent in using self-reports of screening are well known , this study also identified biases in using MRR data in clinics located in underserved areas . Impact : LHA interventions show promise for improving screening behaviors among nonadherent women from underserved population s. Cancer Epidemiol Biomarkers Prev ; 20(5 ) ; 835–43 . © 2011 AACR


Title 4:
The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
Abstract 4:
OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity


Title 5:
Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women
Abstract 5:
INTRODUCTION U.S. Hispanic women suffer a disproportionate burden of cervical cancer , with incidence and mortality rates almost twice that of whites . Community health workers , or promotoras , are considered a potential strategy for eliminating such racial and ethnic health disparities . The current study is a r and omized trial of a promotora-led educational intervention focused on cervical cancer in a local Hispanic community . METHODS Four promotoras led a series of two workshops with community members covering content related to cervical cancer . Sociodemographic characteristics , cervical cancer risk , previous screening history , cervical cancer knowledge , and self-efficacy were measured by a pre-intervention question naire . The post-intervention question naire measured the following outcomes : cervical cancer knowledge ( on a 0–6 scale ) , self-efficacy ( on a 0–5 scale ) , and receipt of Pap smear screening during the previous 6 months ( dichotomous ) . Univariate analyses were performed using chi square , t-test , and the Mann – Whitney test . Multivariate logistic regression was used to model the association between explanatory variables and receipt of Pap smear screening . RESULTS There were no statistically significant differences between the two experimental groups at baseline . Follow-up data revealed significant improvements in all outcome measures : Pap smear screening ( 65 % vs. 36 % , p-value 0.02 ) , cervical cancer knowledge ( 5.4 vs. 3.5 , p-value < 0.001 ) , and self-efficacy ( 4.7 vs. 4.0 , p-value 0.002 ) . In multivariate analysis , cervical cancer knowledge ( OR 1.68 , 95 % CI 1.10 - 2.81 ) and intervention group assignment ( OR 6.74 , 95 % CI 1.77 - 25.66 ) were associated with receiving a Pap smear during the follow-up period . DISCUSSION Our r and omized trial of a promotora-led educational intervention demonstrated improved Pap screening rates , in addition to increased knowledge about cervical cancer and self-efficacy . The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable population s about the diseases that disproportionately affect them . Future research should evaluate such programs on a larger scale , and identify novel targets for intervention


Title 6:
Applying the Transtheoretical Model to evaluate the effect of a call-recall program in enhancing Pap smear practice: a cluster randomized trial.
Abstract 6:
OBJECTIVE The objective of this study was to evaluate the effect of a call-recall approach in enhancing Pap smear practice by changes of motivation stage among non-compliant women . METHODS A cluster r and omized controlled trial with parallel and un-blinded design was conducted between January and November 2010 in 40 public secondary schools in Malaysia among 403 female teachers who never or infrequently attended for a Pap test . A cluster r and omization was applied in assigning schools to both groups . An intervention group received an invitation and reminder ( call-recall program ) for a Pap test ( 20 schools with 201 participants ) , while the control group received usual care from the existing cervical screening program ( 20 schools with 202 participants ) . Multivariate logistic regression was performed to determine the effect of the intervention program on the action stage ( Pap smear uptake ) at 24 weeks . RESULTS In both groups , pre-contemplation stage was found as the highest proportion of changes in stages . At 24 weeks , an intervention group showed two times more in the action stage than control group ( adjusted odds ratio 2.44 , 95 % CI 1.29 - 4.62 ) . CONCLUSION The positive effect of a call-recall approach in motivating women to change the behavior of screening practice should be appreciated by policy makers and health care providers in developing countries as an intervention to enhance Pap smear uptake


Title 7:
Do cervical cancer screening rates increase in association with an intervention designed to increase mammography usage?
Abstract 7:
OBJECTIVES To assess cervical cancer screening behaviors among underserved women participating in an intervention design ed to increase mammography use . METHODS This was a r and omized trial of 897 women from three racial groups ( white , African American , Native American ) living in a rural county in North Carolina . Baseline and followup surveys were completed by 815 women ; 775 women provided data to be included in these analyses . The intervention group received an educational program focused on mammography delivered by a lay health advisor , and the control group received a physician letter/brochure focusing on Pap tests . RESULTS Women in both the intervention ( OR 1.70 ; 1.31 , 2.21 , p < 0.001 ) and control groups ( OR 1.38 ; 1.04 , 1.82 , p = 0.025 ) significantly increased cervical cancer screening rates within risk appropriate guidelines . No differences by racial group were documented . Women categorized in the high-risk group for developing cervical cancer ( > 2 sexual partners , age < 18 years at first sexual intercourse , smoker ; treated for sexually transmitted disease [ STD ] or partner with treated STD ) significantly ( OR 1.88 ; 1.54 , 2.28 , p < 0.001 ) increased Pap test completion . However , a nonsignificant increase ( OR 1.25 ; 0.87 , 1.79 , p = 0.221 ) in Pap test completion was demonstrated in women categorized as low risk for cervical cancer . CONCLUSIONS This study suggests that women in an intensive behavioral intervention design ed to increase mammography use may also increase Pap test completion , similar to a minimal intervention focused only on increasing Pap test completion . These results have implication s for the design and evaluation of behavioral intervention studies
Almost all levels of the interventions boosted the screening uptake and the Pap test .
However , the individual level health education interventions were prioritized in many of the studies .
Conclusion The review indicated that health education interventions have immense contributions in boosting the screening uptake .
However , the effectiveness varies with study setting , population s and the way of delivery .