gms | German Medical Science

Launched in October 2023, this innovative study under the SOLACE (Strengthening the Screening of Lung Cancer in Europe) project's Work Package 5, spearheaded by DKFZ and co-funded by the EU4Health Programme 2021–2027 (Grant No. 101101187), employs ambassador-based recruitment strategies in Mannheim to increase lung cancer screening uptake among socioeconomically diverse populations [1]. Mannheim's unique demographic composition, characterized by significant socioeconomic diversity and clear regional distinctions in social structure, presents an optimal setting for testing these innovative outreach methods.

Historically, conventional lung cancer screening initiatives have struggled with low engagement, achieving only a 1- 4% response rate through standard letter invitations [2]. In response, this project has introduced a novel ambassador-based intervention that has shown a promising increase in engagement. As of February 2024, preliminary results indicate that 228 participants have been actively involved, with recruitment primarily facilitated through ambassadors using flyers and conducting personal interviews. These ambassadors, who are themselves the participants of the existing Lung cancer screening trial (4 In The Lung Run) [3], use their networks to bridge the gap between the screening program and hard-to-reach populations, fostering trust and awareness through familiar faces and relationships.

Despite these advances, the project faces significant challenges. The majority of engaged participants do not belong to the most socially deprived segments of the population, which are the primary targets of this initiative. This misalignment highlights a critical gap in reaching the intended demographic and underscores the need for strategic refinement [4]. Detailed data analysis shows that while there is robust contact frequency among eligible participants, most recruited contacts fall outside the desired demographic and social criteria, suggesting that current methods need to be more tailored to reach and resonate with the intended audience.

Moreover, the project deeply explores the social dynamics within these networks, examining the types of relationships and interactions that influence health behaviors [5]. Early findings reveal that interactions among ambassadors and their contacts typically occur within close-knit circles, yet this closeness does not necessarily lead to higher screening participation. Additionally, significant language barriers exist, with a substantial portion of potential participants being non-native German speakers, indicating that current communication strategies may not be sufficiently inclusive.

Interviews conducted during the screening process provide further insights into participants' health literacy, smoking behaviors, and social networks, as well as their beliefs about lung cancer screening and the associated stigma of smoking. These insights are crucial for understanding the complex barriers to participation and are actively used to tailor more effective recruitment strategies.

As this research progresses, it continues to shape the broader goals of the SOLACE project, emphasizing the development of culturally and socially sensitive recruitment strategies. These strategies are vital for the upcoming European Lung Cancer Screening Alliance (ELCSA), aiming to craft sustainable and effective approaches that are well-adapted to the diverse needs of European populations. This project not only seeks to enhance immediate screening uptake but also aims to contribute significantly to the overall accessibility and effectiveness of lung cancer screening across Europe, ensuring that these methods are inclusive and equitable

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.