By Dr Nicholas Clarke, Research Fellow at the School of Population Health, RCSI University of Medicine and Health Sciences
We’ve published new research which shows that posting a BowelScreen home-test kit directly to people who are eligible could help people to take part in bowel screening.
Background
When eligible people are sent an invitation letter to take part in BowelScreen for the first time, they are asked to contact the programme by phone, email or online to consent to take part and request a home-test kit. We wanted to see if more people would take part if we sent them the test kit, without the need for them to contact BowelScreen.
Why we did the research
High uptake in bowel screening is important to ensure the BowelScreen programme is contributing to a reduction in the number of people diagnosed with bowel cancer and a reduction in the number of deaths from bowel cancer. Uptake in BowelScreen is below our 50% target.
The research aimed to explore ways to improve uptake.
What we did
We used two interventions as follows:
- sending the test kit directly to people who had not responded to the initial invitation letter
- sending a modified reminder letter.
We co-designed our modified letter with public and patient representatives. The letter was aimed at overcoming some of the barriers to bowel screening that people told us about in previous research including:
- feeling cancer is uncurable
- feeling cancer is a death sentence
- feeling that if you have a healthy lifestyle you don’t need to be screened for bowel cancer
- feeling there might be a better test.
We also looked at uptake in people living in lower socioeconomic areas to see if the interventions increased the number of people taking the bowel screening test in these areas.
How we did it
We put 8,424 people who were due their first BowelScreen invitation into four groups. We used a different intervention on each group and we compared the uptake in each group to the existing BowelScreen reminder approach.
The different interventions for the four groups were:
- the standard reminder letter (need to contact BowelScreen to request a test kit)
- a modified reminder letter (need to contact BowelScreen to request a test kit)
- the home-test kit with the reminder letter (no need to contact BowelScreen)
- the home-test kit with a modified reminder letter (no need to contact BowelScreen)
What we found
We found that 6% more people took the BowelScreen test when they were sent the home test kit directly with the reminder letter.
- Uptake was 48% in the standard reminder letter group.
- Uptake was 50% in the modified reminder letter group.
- Uptake was 54% in the two groups that received the home-test kit with the reminder letter (without the need to contact BowelScreen to consent to take part and ask for a kit).
We also found that sending the test kit with the reminder letter increased uptake in lower socioeconomic areas by 5%. There was also some indication that sending the test kit with the modified reminder letter worked well in women living in lower socioeconomic areas.
What this tells us
This tells us that people were more likely to take part in bowel screening if they were sent the home-test kit without the need to contact the BowelScreen programme first.
Conclusion
This research provides evidence for decision-makers around measures that will increase equitable uptake of bowel screening, remove barriers, and enable more people to take part. Research should continue to examine the effect of using different messages to increase uptake with different groups within the population, especially among those living in lower socioeconomic areas.
- ‘Interventions to increase uptake in a faecal-immunochemical test population-based colorectal cancer screening programme: a quasi-experimental study of first-time invitees’ is published in the Journal of the American Cancer Society.
- This research was supported by the National Screening Service and was funded by a grant from the Irish Cancer Society.