The Effectiveness of Incentives on Cancer Screening among Indigenous Populations: Systematic Review

Abstract Indigenous peoples experience inequitable access to population-based cancer screening programs compared with non-Indigenous populations. Incentives including financial incentives, outreach programs, and educational programs have been used to increase participation; however, their effectiveness among Indigenous populations remains unclear. This systematic review evaluated the effectiveness of incentives on cancer screening participation among Indigenous populations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Web of Science, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for published articles from inception to September 2025. Eligible articles were reviewed and appraised by 2 independent reviewers using the Mixed Methods Appraisal Tool. A total of 35 articles were included, reporting on education programs (63%), outreach programs (23%), and a combination of both (14%). Education-based interventions improved cancer screening participation rates (ranging from 11.7% to 370%) and/or knowledge among Indigenous populations. Outreach programs, particularly those with personalized follow-ups, improved participation by more than 31%. Combining outreach and education was also effective, especially with trained healthcare workers and tailored community approaches. Financial and nonfinancial incentives like transportation and childcare increased engagement. Approaches co-designed with Indigenous communities were more effective in improving knowledge, attitudes, and increasing screening rates. Culturally tailored incentives, co-designed with Indigenous communities, should inform future cancer screening research, policy, and practice.