title: Use of a 12 months' self-referral reminder to facilitate uptake of bowel scope (flexible sigmoidoscopy) screening in previous non-responders: a London-based feasibility study.
abstract: BACKGROUND
  In March 2013, NHS England extended its national Bowel Cancer Screening Programme to include 'one-off' Flexible Sigmoidoscopy screening (NHS Bowel Scope Screening, BSS) for men and women aged 55. With less than one in two people currently taking up the screening test offer, there is a strong public health mandate to develop system-friendly interventions to increase uptake while the programme is rolling out. This study aimed to assess the feasibility of sending a reminder to previous BSS non-responders, 12 months after the initial invitation, with consideration for its potential impact on uptake.
  
  
  METHODS
  This study was conducted in the ethnically diverse London Boroughs of Brent and Harrow, where uptake is below the national average. Between September and November 2014, 160 previous non-responders were randomly selected to receive a reminder of the opportunity to self-refer 12 months after their initial invitation. The reminder included instructions on how to book an appointment, and provided options for the time and day of the appointment and the gender of the endoscopist performing the test. To address barriers to screening, the reminder was sent with a brief locally tailored information leaflet designed specifically for this study. Participants not responding within 4 weeks were sent a follow-up reminder, after which there was no further intervention. Self-referral rates were measured 8 weeks after the delivery of the follow-up reminder and accepted as final.
  
  
  RESULTS
  Of the 155 participants who received the 12 months' reminder (returned to sender, n=5), 30 (19.4%) self-referred for an appointment, of which 24 (15.5%) attended and were successfully screened. Attendance rates differed by gender, with significantly more women attending an appointment than men (20.7% vs 8.8%, respectively; OR=2.73, 95% CI=1.02-7.35, P=0.05), but not by area (Brent vs Harrow) or area-level deprivation. Of the 30 people who self-referred for an appointment, 27 (90%) indicated a preference for a same-sex practitioner, whereas three (10%) gave no preference. Preference for a same-sex practitioner was higher among women than men (χ(2)=7.78, P<0.05), with only 67% of men (six of nine) requesting a same-sex practitioner, compared with 100% of women (n=21).
  
  
  CONCLUSIONS
  Sending previous non-responders a 12 months' reminder letter with a brief information leaflet is a feasible and efficacious intervention, which merits further investigation in a randomised controlled trial.
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kerrison
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
authors.forename: Lesley M
authors.initials: LM
authors.lastname: McGregor
authors.affiliation: St. Mark's Bowel Cancer Screening Centre, St. Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Marshall
authors.affiliation: Resonant Behaviour Change and Social Marketing, Canterbury Court, 1-3 Brixton Road, London, SW9 6DE, UK.
authors.forename: John
authors.initials: J
authors.lastname: Isitt
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Counsell
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: von Wagner
mesh_terms: D001071:Appointments and Schedules; D055088:Early Detection of Cancer; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012017:Referral and Consultation; D017010:Reminder Systems; D012648:Self Care; D012812:Sigmoidoscopy