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Published: 30 August 2022

Introducing a research project designed to improve bowel cancer screening uptake

By: Dr Alice Le Bonniec 

Bowel cancer (or colorectal cancer) is the one of the most commonly occurring types of cancer in the world*. If bowel cancer is diagnosed early, in the majority of cases people can be treated more successfully and have better outcomes. Screening is a very effective way of reducing a person’s risk of developing bowel cancer. However, of those people invited for screening by BowelScreen, the national bowel screening programme, only 41.9%** take part. The CRITICALS project aims to improve bowel cancer screening uptake and in so doing, aims to improve patient outcomes.

What is the CRITICALS Project?

CRITICALS stands for Creation of an Innovative Intervention for Improving Colorectal Cancer Screening. The project is funded by the Irish Cancer Society’s Social, Nursing, and Allied Health Sciences Post-Doctoral Fellowship that was awarded to Dr Alice Le Bonniec at the National University of Ireland, Galway.

How is the research done?

We are developing a new intervention with key stakeholders in the form of printed materials that will be sent out with screening invitations. This is being done in three steps: 

  1. Review of the scientific literature: We have gathered and summarised information from published studies examining why people do not participate in screening.
  2. Workshops with members of the public, healthcare professionals and National Screening Service members to develop the intervention: Based on the results of two workshops, new materials have been developed to be sent when inviting people to take part in screening.
  3. A feasibility study of the intervention: This study will include interviews and questionnaires with members of the public who receive the intervention material and with people who receive the usual invitation, to assess their attitudes, screening intention and participation in screening. 

Public, patient and stakeholder involvement

We have formed a Stakeholder Steering Committee ‑ made up of healthcare professionals, screening professionals and public and patient representatives ‑ who advise us to make sure the project is relevant to the needs of these groups and fits with policy and practice. A Public and Patient Involvement Advisory Panel has also been created, consisting of people who are invited by the screening programme, and participants with experience of living with bowel cancer. This panel attends Stakeholder Steering Committee meetings and advises us on all aspects of the research.

First results of the project

Findings of the review of the literature suggested that non-participation in screening may be due to:

  • Ambivalence and postponement (that is, people have the intention to participate but they put off participating, and finally forget)
  • Negative reactions to the screening invitation (e.g. disgust, fear, embarrassment),
  • Lack of awareness, or
  • Lack of support from healthcare professionals. 

Workshop results suggested that we could improve the way people are invited to participate in screening in three ways: 

  1. Rewording the current invitation letter to make it more appealing;
  2. Adding an information leaflet summary (which gives the main information in a short format) to highlight key points about the screening process and the benefits and limitations of screening;
  3. Adding narratives (testimonials) of participants, members of public and GPs regarding their positive experience with bowel cancer screening.

Next steps

The feasibility study will start in September 2022. Based on the findings of this study, we will know how people react to the new invitation material and if it could be used to improve participation in bowel cancer screening in the future.

Dr Alice Le Bonniec is a Postdoctoral Researcher with the Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway. The mentor on this project is Dr Jenny McSharry, Health Behaviour Change Research Group School of Psychology, National University of Ireland, Galway.


* IARC Working Group on the Evaluation of Cancer-Preventive Interventions. Colorectal cancer screening. Lyon (FR): International Agency for Research on Cancer; 2019. Available from:

BowelScreen Programme Report 2018 – 2019