Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial
Samuel G. Smith,
Jane Wardle,
Wendy Atkin,
Rosalind Raine,
Lesley M. McGregor,
Gemma Vart,
Steve Morris,
Stephen W. Duffy,
Susan Moss,
Allan Hackshaw,
Stephen Halloran,
Ines Kralj-Hans,
Rosemary Howe,
Julia Snowball,
Graham Handley,
Richard F. Logan,
Sandra Rainbow,
Steve Smith,
Mary Thomas,
Nicholas Counsell,
Christian von Wagner
Affiliations
Samuel G. Smith
Leeds Institute of Health Sciences, University of Leeds
Jane Wardle
Department of Behavioural Science and Health, University College London
Wendy Atkin
Faculty of Medicine, Department of Surgery & Cancer, Imperial College London
Rosalind Raine
Department of Applied Health Research, University College London
Lesley M. McGregor
Department of Behavioural Science and Health, University College London
Gemma Vart
Department of Behavioural Science and Health, University College London
Steve Morris
Department of Applied Health Research, University College London
Stephen W. Duffy
Wolfson Institute of Preventive Medicine, Queen Mary University of London
Susan Moss
Wolfson Institute of Preventive Medicine, Queen Mary University of London
Allan Hackshaw
Cancer Research UK & UCL Cancer Trials Centre, University College London
Stephen Halloran
Bowel Cancer Screening Southern Programme Hub
Ines Kralj-Hans
Academic Neuroscience Centre, King’s College London
Rosemary Howe
Faculty of Medicine, Department of Surgery & Cancer, Imperial College London
Julia Snowball
Bowel Cancer Screening Southern Programme Hub
Graham Handley
North East Bowel Cancer Screening Hub
Richard F. Logan
Eastern Hub of the Bowel Cancer Screening Programme
Sandra Rainbow
Bowel Cancer Screening Programme London Programme Hub
Steve Smith
Midlands & North West Bowel Cancer Screening Programme Hub
Mary Thomas
Department of Applied Health Research, University College London
Nicholas Counsell
Cancer Research UK & UCL Cancer Trials Centre, University College London
Christian von Wagner
Department of Behavioural Science and Health, University College London
Abstract Background Uptake of colorectal cancer screening is low in the English NHS Bowel Cancer Screening Programme (BCSP). Participation in screening is strongly associated with socioeconomic status. The aim of this study was to determine whether a supplementary leaflet providing the ‘gist’ of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP. Methods The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59–74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet (‘SI’). The intervention group received the SI booklet and the Gist leaflet (‘SI + Gist’) which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles. Results In November 2012, 163,525 individuals were allocated to either the ‘SI’ intervention (n = 79,104) or the ‘SI + Gist’ group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92–1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups. Conclusions Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research. Trial registration ISRCTN74121020 , registered: 17/20/2012.
