Reducing the Social Gradient in Uptake of the NHS Colorectal Cancer Screening Programme Using a Narrative-Based...

Area of Science:

• Public Health
• Health Services Research
• Cancer Screening

Background:

• Socioeconomic inequalities persist in colorectal cancer (CRC) screening uptake.
• Targeted interventions are needed to improve equitable access to screening programs.

Purpose of the Study:

• To evaluate the effectiveness of a supplementary narrative leaflet in reducing socioeconomic disparities in CRC screening uptake.
• To assess the impact of enhanced information materials on screening participation across different socioeconomic strata.

Main Methods:

• A cluster randomized controlled trial involving 150,417 adults (59-74 years) invited for guaiac Faecal Occult Blood test (gFOBt) screening.
• Comparison of screening uptake between standard information (SI) and SI plus a narrative leaflet (SI + N).
• Analysis of uptake rates overall and stratified by socioeconomic status (SES) quintiles.

Main Results:

• Overall screening uptake was 57.7% and did not significantly differ between the control (58.5%) and intervention (56.7%) arms (OR=0.93, p=0.27).
• No significant interaction was observed between the intervention group and SES quintile (p=0.44), indicating no reduction in the SES gradient.
• The addition of a narrative leaflet did not alter the socioeconomic disparities in CRC screening uptake.

Conclusions:

• A supplementary narrative leaflet added to existing materials does not effectively reduce socioeconomic inequalities in colorectal cancer screening uptake.
• The pragmatic trial design, requiring additions rather than replacements of information, may have limited the intervention's impact.
• Further research is needed to identify effective strategies for mitigating socioeconomic disparities in cancer screening.