In summary, this evaluation of the FIT supports the introduction of FIT as a first-line test, even when colonoscopy capacity is limited.

Screening is important for early detection of colorectal cancer. Our aim was to determine whether a simple anticipated regret (AR) intervention could increase uptake of colorectal cancer screening. A randomised controlled trial of a simple, questionnaire-based AR intervention, delivered alongside existing pre-notification letters, was conducted. A total of 60,000 adults aged 50–74 years from the Scottish National Screening programme were randomised into the following groups: (1) no questionnaire (control), (2) Health Locus of Control questionnaire (HLOC) or (3) HLOC plus AR questionnaire. The primary outcome was return of the guaiac faecal occult blood test (FOBT). The secondary outcomes included intention to return test kit and perceived disgust (ICK). A total of 59,366 people were analysed as allocated (intention-to-treat (ITT)); no overall differences were seen between the treatment groups on FOBT uptake (control: 57.3%, HLOC: 56.9%, AR: 57.4%). In total, 13,645 (34.2%) individuals returned the questionnaires. Analysis of the secondary questionnaire measures showed that AR indirectly affected FOBT uptake via intention, whilst ICK directly affected FOBT uptake over and above intention. The effect of AR on FOBT uptake was also moderated by intention strength: for less-than-strong intenders only, uptake was 4.2% higher in the AR (84.6%) versus the HLOC group (80.4%) (95% CI for difference (2.0, 6.5)). The findings show that psychological concepts including AR and perceived disgust (ICK) are important factors in determining FOBT uptake. However, the AR intervention had no simple effect in the ITT analysis. It can be concluded that, in those with low intentions, exposure to AR may be required to increase FOBT uptake. The current controlled trials are presented at the website www.controlled-trials.com (number: ISRCTN74986452).

Objectives To assess whether pre-notification is effective in increasing uptake of colorectal cancer screening for all demographic groups. Setting Scottish national colorectal cancer screening programme. Methods Males and females aged 50 -74 years received a faecal occult blood test by post to complete at home. They were randomized to receive in addition: the pre-notification letter, the prenotification letter þ information booklet, or the usual invitation. Overall, 59,953 subjects were included in the trial between 13/04/09 and 29/05/09 and followed to 27/11/09. Prenotification letters were posted two weeks ahead of the screening test kit. Uptake was defined as the return of a screening test and chi-squared tests compared uptake between the trial arms. Logistic regression assessed the impact of the letter and letter þ booklet on uptake independently of gender, age, deprivation and screening round. Results Uptake was higher with both the letter (59.0%) and the letter þ booklet (58.5%) compared with the usual invitation (53.9%, p , 0.0001). This increased uptake was seen for males, females, all age groups and all deprivation categories including least deprived females (letter 69.9%, usual invitation 66.6%) and most deprived males (42.6% vs. 36.1%), the groups with the highest and lowest levels of uptake respectively in the pilot screening rounds conducted prior to the roll out of the programme. Uptake with the pre-notification letter compared with the usual invitation was higher both unadjusted and adjusted for demographic factors (odds ratio 1.24, 95% CI 1.193 -1.294). Conclusions Pre-notification is an effective method of increasing uptake in colorectal cancer screening for both genders and all age and deprivation groups.

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Background Type 2 Diabetes (T2DM) is a global public health priority affecting 425 million adults with 352 million more at risk of developing T2DM. Intensive group programmes focusing on weight loss and physical activity can prevent or postpone the development of T2DM, but certain groups (e.g working age) find it difficult to attend sessions. Digital options offer a flexible alternative with the potential to widen access and increase uptake. The National Health Service of England (NHSE) has initiated a pilot of a national digital Diabetes Prevention Programme (DPP) to determine its feasibility, acceptability and impact. This is the first national digital DPP in the world, and lessons learnt will be of interest internationally. Methods Single arm, pre-post design located in 9 geographic areas with a total population of 5.6 million adults. Adults identified in primary care as being at risk of T2DM were referred to a digital diabetes prevention intervention (DDPI). Baseline data included demographic details (age, gender, ethnicity, highest level of education achieved) and clinical data (weight (kg), Body Mass Index (BMI) and glycated haemoglobin (HbA1c mmol/mol)). Clinical data were collected at baseline, 6 and 12 months, with the primary outcome change in HbA1c at 12 months. Results The programme was effectively implemented in all 9 areas with a total of 5,053 referrals. 3,228 (64%) of those referred registered with a DDPI. Mean baseline values for registered patients was BMI 31.1, Weight 87.7 kg and HbA1c 43.4 mmol/mol. To date, 2,687 patients have reached the 6 month point, of whom 867 dropped out. Mean (95% CI) HbA1c change was -1.6 (-1.8 to -1.4) mmol/mol (n = 1,264) and mean (95% CI) weight change was -4 (-4.3 to -3.7) kg (n = 1,184). Conclusions A national digital DPP is feasible, acceptable to patients and healthcare providers, and appears to be associated with beneficial impacts on HbA1c and weight in those who participate. Key messages A digital DPP is feasible, acceptable and associated with reductions in weight and HbA1c amongst participants. A digital DPP could be a useful part of a public health strategy to combat T2DM.