reducing the social gradient in uptake of the nhs colorectal cancer screening programme using a narrative-based information leaflet: a cluster-randomised trial

reducing the social gradient in uptake of the nhs colorectal cancer screening programme using a narrative-based information leaflet: a cluster-randomised trial

;Lesley M. McGregor;Christian von Wagner;Wendy Atkin;Ines Kralj-Hans;Stephen P. Halloran;Graham Handley;Richard F. Logan;Sandra Rainbow;Steve Smith;Julia Snowball;Mary C. Thomas;Samuel G. Smith;Gemma Vart;Rosemary Howe;Nicholas Counsell;Allan Hackshaw;Stephen Morris;Stephen W. Duffy;Rosalind Raine;Jane Wardle
colloids and surfaces a: physicochemical and engineering aspects 2016 Vol. 2016 pp. -
194
mcgregor2016gastroenterologyreducing

Abstract

Objective. To test the effectiveness of adding a narrative leaflet to the current information material delivered by the NHS English colorectal cancer (CRC) screening programme on reducing socioeconomic inequalities in uptake. Participants. 150,417 adults (59–74 years) routinely invited to complete the guaiac Faecal Occult Blood test (gFOBt) in March 2013. Design. A cluster randomised controlled trial (ISRCTN74121020) to compare uptake between two arms. The control arm received the standard NHS CRC screening information material (SI) and the intervention arm received the standard information plus a supplementary narrative leaflet, which had previously been shown to increase screening intentions (SI + N). Between group comparisons were made for uptake overall and across socioeconomic status (SES). Results. Uptake was 57.7% and did not differ significantly between the two trial arms (SI: 58.5%; SI + N: 56.7%; odds ratio = 0.93; 95% confidence interval: 0.81–1.06; p=0.27). There was no interaction between group and SES quintile (p=0.44). Conclusions. Adding a narrative leaflet to existing information materials does not reduce the SES gradient in uptake. Despite the benefits of using a pragmatic trial design, the need to add to, rather than replace, existing information may have limited the true value of an evidence-based intervention on behaviour.

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