Theory-based modifications of an advanced notification letter improves screening for bowel cancer in men: A randomised controlled trial

doi:10.1016/j.socscimed.2016.06.036

Social Science & Medicine

Volume 165, September 2016, Pages 1-9

https://doi.org/10.1016/j.socscimed.2016.06.036 Get rights and content

Highlights

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Biennial screening is effective for reducing the impact of Bowel Cancer.
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Screening rates in Australia are sub-optimal and particularly problematic in Males.
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This RCT in 9216 men tested theory-based modifications to invitation material.
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Modified advance notification letters significantly improved screening rates.
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Modified invitation letters had no effect on screening uptake.

Abstract

Rationale

Male participation in screening for bowel cancer is sub-optimal. Theory-based interventions provide a means of improving screening uptake.

Objective

To test the efficacy of modifying consumer invitation material in line with continuum and stage theories of health behaviour on screening participation.

Methods

N = 9216 Australian men aged 50–74 years were randomised to one of four trial arms in a 2 × 2 factorial design randomised controlled trial. Participants received either standard invitation material (control group), or combinations of modified advance-notification and invitation letters. A subsample completed baseline and endpoint behavioural surveys.

Results

Participants who received the modified advance notification letter were 12% more likely to screen than those who received the standard version (RR = 1.12, χ²(1) = 10.38, p = 0.001). The modified invitation letter did not impact screening uptake (RR = 0.97, χ²(1) = 0.63, p = 0.424). No significant changes in psychological variables due to the intervention were observed.

Conclusion

Modifications to advance notification letters in line with health behaviour theories significantly improves screening uptake in men.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN12612001122842 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362688.

Section snippets

Background

The Australian National Bowel Cancer Screening Program (NBCSP) offers free Faecal immunochemical test (FIT) screening to those aged 50 years and older at five year intervals with plans to reduce the interval to biennial screening by the year 2020. In order for this program to achieve its full public health benefit, high levels of screening participation are crucial. However, since the program’s inception, participation has been low and it has decreased gradually from 41% in 2006–2007 (

Trial design and setting

The present study was a 2 × 2 factorial design randomised controlled trial conducted in Australia from 2012 to 2014. Full details of the methods for this randomised controlled trial are reported in the published protocol (Duncan et al., 2013) and the study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001122842). Approval for this research was granted by the University of Adelaide’s Human Research Ethics Committee (ref. no. H-2012-040). A CONSORT flow chart

Participant flow

The intervention was mailed to all participants allocated to the intervention only group (i.e., ITT sample). Amongst this sample (n = 403), 5.9% were not eligible to participate in screening (n = 21), or reported that they did not require screening (medical reasons, up to date; n = 382) (i.e., RED sample, sensitivity analysis only). The drop-out rate was comparable across the groups (see Fig. 1).

The baseline behavioural survey was returned by 922 participants (38.4% response rate) and the

Discussion

The primary aim of this study was to determine if a messaging strategy which matched the content of screening invitations with theorised stages of readiness to screen and related salient psychosocial variables, led to greater screening participation in men compared to the standard approach. In this context, the present study is a test of the extent to which the TTM and/or other stage-based theories of behaviour might be successfully applied to large scale population-based screening programs and

Conclusions

An advance notification letter that included messages designed to decrease perceived barriers to screening and increase engagement with sources of social support and influence with regard to screening, increased men’s participation in FIT screening compared to a standard letter that replicated current practice. Changes to the content of the advance notification could be easily implemented into standard practice in Australia yet further research is required to determine if these changes would

Acknowledgements

This project was funded by the National Health and Medical Research Council of Australia; project grant number 1026510.

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