Evaluation of a service intervention to improve awareness and uptake of bowel cancer screening in ethnically-diverse areas

Abstract

Background:Uptake of bowel cancer screening is lowest in London, in populations of lower socio-economic status, and in particular ethnic or religious groups.Methods:We report on the evaluation of two interventions to improve uptake in an area including populations of low socio-economic status and considerable ethnic diversity. The interventions were face-to-face health promotion on bowel cancer screening at invitees' general practice and health promotion delivered by telephone only. Nine large general practices in East London were chosen at random to offer face-to-face health promotion, and nine other large practices to offer telephone health promotion, with 24 practices of similar size as comparators. Data at practice level were analysed by Mann–Whitney–Wilcoxon tests and grouped-logistic regression.Results:There were 2034 invitees in the telephone intervention practices, 1852 in the face-to-face intervention practices and 5227 in the comparison practices. Median gFOBt kit uptake in the target population (aged 59–70) was 46.7% in the telephone practices, 43.8% in the face-to-face practices and 39.1% in the comparison practices. Significant improvements in the odds of uptake were observed following telephone intervention in both males (OR=1.39, 95% CI=1.20–1.61, P<0.001) and females (OR=1.49, 95% CI=1.29–1.73, P<0.001), while the face-to-face intervention mainly impacted uptake in males (OR=1.23, 95% CI=1.10–1.36), P<0.001) but did not lead to a significant increase in females (OR=1.12, 95% CI=0.96–1.29, P=0.2).Conclusions:Personally delivered health promotion improved uptake of bowel cancer screening in areas of low socio-economic status and high ethnic diversity. The intervention by telephone appears to be the most effective method.

Structuring Health in Colorectal Cancer Screening Conversations: An Analysis of Intersecting Activity Systems

“…Primary care physicians can be encouraged to recommend more frequent colonoscopies for higher risk patients. Prior research indicates the importance of primary care physicians for colonoscopy screening (e.g., Shankleman et al, 2014), and results of this study underscore that importance.…”

“…Recent studies examined communication-centered interventions and found some success with one-on-one education between healthcare workers and recipients, client reminders (e.g., postcards or emails), reducing structural barriers to screening (e.g., scheduling or transportation assistance), and provider assessment and feedback evaluations (e.g., Community Preventive Services Task Force, 2012; Shankleman et al, 2014). …”

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

“…An encouraging recent intervention study tested the provision of health promotion information either face to face or by telephone through general practices with a large minority ethnic population and found that these approaches led to significant improvements in the likelihood of bowel cancer screening uptake. 88 Approaches should further be delivered within community and faith settings in partnership with representatives from these settings, and be backed up with the use of local ethnic media. Given the role of children in mediating access to health for older people across South Asian communities, it may also be beneficial to raise general and practical awareness of the NHS BCSP across all age groups.…”

Ethnic profiles in the National Bowel Cancer Screening Programme – results from a multicentre study

“…Biennial FOBT has been part of a national screening programme in the UK since 2007, and is aimed at reducing CRC mortality, mainly through the early detection and subsequent improved survival of screen‐detected cancers . Although data on ethnicity are not routinely collected as part of the FOBT screening process, indirect evidence points to a low uptake of FOBT among minority ethnic groups . There are no published data comparing minority ethnic groups and white British with regard to the three main groups in the FOBT screening programme – screen detected cancers, interval cancers (IC; cancers that develop in screening patients within 2 years subsequent to a negative FOBT) or cancers in patients who have declined to participate in the FOBT programme.…”