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Gastroenterology Research and Practice
Volume 2016 (2016), Article ID 3670150, 10 pages
Research Article

Reducing the Social Gradient in Uptake of the NHS Colorectal Cancer Screening Programme Using a Narrative-Based Information Leaflet: A Cluster-Randomised Trial

1Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
2Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK
3Department of Biostatistics, King’s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
4NHS Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, Surrey GU2 7YS, UK
5Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK
6NHS Bowel Cancer Screening North East Programme Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
7NHS Bowel Cancer Screening Eastern Programme Hub, Nottingham University Hospitals, Nottingham NG7 2UH, UK
8NHS Bowel Cancer Screening London Programme Hub, Northwick Park and St Mark’s Hospitals, Harrow, Middlesex HA1 3UJ, UK
9NHS Bowel Cancer Screening Midlands and North West Programme Hub, Hospital of St Cross, Barby Road, Rugby CV22 5PX, UK
10Department of Applied Health Research, University College London, London WC1E 7HB, UK
11Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
12Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, London W1T 4TJ, UK

Received 29 September 2015; Revised 24 November 2015; Accepted 9 December 2015

Academic Editor: Carlene Wilson

Copyright © 2016 Lesley M. McGregor et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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; ). There was no interaction between group and SES quintile (). 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.