Advance notification of coming invitation letter for health screening increases participation rate

Note: analysis based on my Behavioral Orchestration and Analysis framework explained here.


Senore, C, Ederle, A, DePretis, G, Magnani, C, Canuti, D, Deandrea, S & Bisanti, L 2015, ‘Invitation strategies for colorectal cancer screening programmes: The impact of an advance notification letter’, Preventive Medicine, vol. 73, pp. 106–11.


To estimate the impact of advance notifications of invitation letter for screening on the participation rate in the screening.

Changes implemented

Choice Architecture

Choice ergonomics and usability; user experience

  • Termed “Pre-suasion” techniques: instead of receiving just the standard invitation letter for a bowel cancer screening, some subjects received advanced notifications before the actual invitation. The treatments were as follow:
    • A: standard invitation letter
    • B: advance notification followed after 1month by the standard invitation
    • C: B+indication to contact the general practitioner (GP) to get advice about the decision to be screened.


From the study:

The advance notification was associated with a 20% increase in the attendance among 15,655 people invited for FS (B vs A – RR: 1.17, 95% CI: 1.10-1.25; C vs A – RR: 1.19, 95% CI: 1.12-1.27); the incremental cost ranged between 10 and 9 Euros. Participation in FIT screening (N=23,543) was increased only with simple pre-notification (B vs A – RR: 1.06, 95% CI: 1.02-1.10); the incremental cost was 22.5 Euros. GP consultation rate was not increased in group C.


Great example of a re-usable technique that has many facets but rely primarily on priming and status quo bias. There are several such studies, all replicating the same positive effect though magnitude can vary.