title: Reducing the Social Gradient in Uptake of the NHS Colorectal Cancer Screening Programme Using a Narrative-Based Information Leaflet: A Cluster-Randomised Trial.
abstract: Objective. To test the effectiveness of adding a narrative leaflet to the current information material delivered by the NHS English colorectal cancer (CRC) screening programme on reducing socioeconomic inequalities in uptake. Participants. 150,417 adults (59-74 years) routinely invited to complete the guaiac Faecal Occult Blood test (gFOBt) in March 2013. Design. A cluster randomised controlled trial (ISRCTN74121020) to compare uptake between two arms. The control arm received the standard NHS CRC screening information material (SI) and the intervention arm received the standard information plus a supplementary narrative leaflet, which had previously been shown to increase screening intentions (SI + N). Between group comparisons were made for uptake overall and across socioeconomic status (SES). Results. Uptake was 57.7% and did not differ significantly between the two trial arms (SI: 58.5%; SI + N: 56.7%; odds ratio = 0.93; 95% confidence interval: 0.81-1.06; p = 0.27). There was no interaction between group and SES quintile (p = 0.44). Conclusions. Adding a narrative leaflet to existing information materials does not reduce the SES gradient in uptake. Despite the benefits of using a pragmatic trial design, the need to add to, rather than replace, existing information may have limited the true value of an evidence-based intervention on behaviour.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
authors.forename: Lesley M
authors.initials: LM
authors.lastname: McGregor
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: von Wagner
authors.affiliation: Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Atkin
authors.affiliation: Department of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
authors.forename: Ines
authors.initials: I
authors.lastname: Kralj-Hans
authors.affiliation: NHS Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, Surrey GU2 7YS, UK; Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Halloran
authors.affiliation: NHS Bowel Cancer Screening North East Programme Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Handley
authors.affiliation: NHS Bowel Cancer Screening Eastern Programme Hub, Nottingham University Hospitals, Nottingham NG7 2UH, UK.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Logan
authors.affiliation: NHS Bowel Cancer Screening London Programme Hub, Northwick Park and St Mark's Hospitals, Harrow, Middlesex HA1 3UJ, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rainbow
authors.affiliation: NHS Bowel Cancer Screening Midlands and North West Programme Hub, Hospital of St Cross, Barby Road, Rugby CV22 5PX, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Smith
authors.affiliation: NHS Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, Surrey GU2 7YS, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Snowball
authors.affiliation: Department of Applied Health Research, University College London, London WC1E 7HB, UK.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Thomas
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK; Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Smith
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Vart
authors.affiliation: Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Howe
authors.affiliation: Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, London W1T 4TJ, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Counsell
authors.affiliation: Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, London W1T 4TJ, UK.
authors.forename: Allan
authors.initials: A
authors.lastname: Hackshaw
authors.affiliation: Department of Applied Health Research, University College London, London WC1E 7HB, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
authors.affiliation: Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Duffy
authors.affiliation: Department of Applied Health Research, University College London, London WC1E 7HB, UK.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Raine
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle