Background/Objectives: Participation in population-based cancer screening programs for breast, cervical, and colorectal cancers remains suboptimal despite robust evidence supporting their clinical effectiveness. This systematic review aims to synthesize current evidence on how organizational determinants influence adherence and participation in cancer screening programs across diverse health system contexts. Methods: We conducted a systematic review following PRISMA guidelines. PubMed and Scopus were searched for studies published between January 2015 and January 2025 that evaluated structured cancer screening interventions with a specific focus on organizational strategies. Only studies reporting quantitative outcomes related to participation or adherence were included. A total of 26 studies were selected for synthesis. Results: Successful interventions shared key organizational features such as centralized coordination, active invitation systems, and integrated quality assurance mechanisms. Community-based outreach and culturally tailored education were particularly effective in increasing participation among underserved populations. Digital tools, including reinforcement learning–based reminders and mobile apps, demonstrated higher effectiveness when integrated within broader organizational ecosystems. Audit and feedback mechanisms improved adherence modestly, especially when aligned with quality improvement initiatives. However, significant variability was noted across cancer types and healthcare settings. Conclusions: Organizational strategies play a critical role in determining the reach and impact of cancer screening programs. Interventions that combine structural standardization with community engagement and digital accessibility offer the greatest promise. Policymakers should prioritize integrated, equity-oriented, and data-informed frameworks to enhance screening participation and reduce disparities.
Organizational Determinants, Outcomes Related to Participation and Adherence to Cancer Public Health Screening: A Systematic Review
Daniela Amicizia;Maria Francesca Piazza;Federico Grammatico;Francesca Marchini;Matteo Astengo;Irene Schenone;Gabriella Paoli;Filippo Ansaldi
2025-01-01
Abstract
Background/Objectives: Participation in population-based cancer screening programs for breast, cervical, and colorectal cancers remains suboptimal despite robust evidence supporting their clinical effectiveness. This systematic review aims to synthesize current evidence on how organizational determinants influence adherence and participation in cancer screening programs across diverse health system contexts. Methods: We conducted a systematic review following PRISMA guidelines. PubMed and Scopus were searched for studies published between January 2015 and January 2025 that evaluated structured cancer screening interventions with a specific focus on organizational strategies. Only studies reporting quantitative outcomes related to participation or adherence were included. A total of 26 studies were selected for synthesis. Results: Successful interventions shared key organizational features such as centralized coordination, active invitation systems, and integrated quality assurance mechanisms. Community-based outreach and culturally tailored education were particularly effective in increasing participation among underserved populations. Digital tools, including reinforcement learning–based reminders and mobile apps, demonstrated higher effectiveness when integrated within broader organizational ecosystems. Audit and feedback mechanisms improved adherence modestly, especially when aligned with quality improvement initiatives. However, significant variability was noted across cancer types and healthcare settings. Conclusions: Organizational strategies play a critical role in determining the reach and impact of cancer screening programs. Interventions that combine structural standardization with community engagement and digital accessibility offer the greatest promise. Policymakers should prioritize integrated, equity-oriented, and data-informed frameworks to enhance screening participation and reduce disparities.
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