A randomised controlled trial of a reminder intervention to promote bowel scope screening uptake

Abstract

Background: This randomised controlled trial aimed to test whether a mailed reminder of the opportunity to self-refer into the English Bowel Scope Screening (BSS) programme, sent one year post initial invitation, could facilitate uptake. We additionally aimed to compare the impact of the national information leaflet with a locally-tailored social marketing leaflet. Methods: 1,383 previous non-participants in London were randomly assigned to receive no reminder (Usual Care, UC), a reminder & ‘standard facts’ booklet (Intervention-A), or a reminder & locally-tailored leaflet designed to address barriers to screening (Intervention-B). The reminder included information on how-to-book an appointment, and provided options for the gender of the endoscopist and the day/time of the appointment. Participants not responding within four weeks were sent a follow-up reminder. The primary outcome was the proportion attending within each group eight weeks after the follow-up reminder. Findings: 461 participants were randomised to each group and 0.2%, 10.4%, and 15.2% of individuals attended an appointment in the UC, Intervention-A and Intervention-B groups respectively. Individuals receiving UC were less likely to attend an appointment than individuals in the Intervention-A (X2=47.61; p<0.01) and Intervention-B groups (X2=72.65; p<0.01), and individuals in Intervention-A less likely than individuals in Intervention-B (X2=4.7; p=0.04). Adenomas were detected in 24.6% of the intervention participants, which is comparable to the current programme in London. Discussion: Sending non-participants a self-referral reminder facilitated uptake and led to the detection of adenomas. The reminder was most effective when accompanied by a leaflet designed to address barriers to the test.