Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials

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Title: Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials
Authors: Wardle, J
Von Wagner, C
Kralj-Hans, I
Halloran, SP
Smith, SG
McGregor, LM
Vart, G
Howe, R
Snowball, J
Handley, G
Logan, RF
Rainbow, S
Smith, S
Thomas, MC
Counsell, N
Morris, S
Duffy, SW
Hackshaw, A
Moss, S
Atkin, W
Raine, R
Item Type: Journal Article
Abstract: Background Uptake in the national colorectal cancer screening programme in England varies by socioeconomic status. We assessed four interventions aimed at reducing this gradient, with the intention of improving the health benefits of screening. Methods All people eligible for screening (men and women aged 60–74 years) across England were included in four cluster-randomised trials. Randomisation was based on day of invitation. Each trial compared the standard information with the standard information plus the following supplementary interventions: trial 1 (November, 2012), a supplementary leaflet summarising the gist of the key information; trial 2 (March, 2012), a supplementary narrative leaflet describing people's stories; trial 3 (June, 2013), general practice endorsement of the programme on the invitation letter; and trial 4 (July–August, 2013) an enhanced reminder letter with a banner that reiterated the screening offer. Socioeconomic status was defined by the Index of Multiple Deprivation score for each home address. The primary outcome was the socioeconomic status gradient in uptake across deprivation quintiles. This study is registered, number ISRCTN74121020. Findings As all four trials were embedded in the screening programme, loss to follow-up was minimal (less than 0·5%). Trials 1 (n=163 525) and 2 (n=150 417) showed no effects on the socioeconomic gradient of uptake or overall uptake. Trial 3 (n=265 434) showed no effect on the socioeconomic gradient but was associated with increased overall uptake (adjusted odds ratio [OR] 1·07, 95% CI 1·04–1·10, p<0·0001). In trial 4 (n=168 480) a significant interaction was seen with socioeconomic status gradient (p=0·005), with a stronger effect in the most deprived quintile (adjusted OR 1·11, 95% CI 1·04–1·20, p=0·003) than in the least deprived (1·00, 0·94–1·06, p=0·98). Overall uptake was also increased (1·07, 1·03–1·11, p=0·001). Interpretation Of four evidence-based interventions, the enhanced reminder letter reduced the socioeconomic gradient in screening uptake, but further reducing inequalities in screening uptake through written materials alone will be challenging.
Issue Date: 9-Dec-2015
Date of Acceptance: 1-Dec-2015
ISSN: 1474-547X
Publisher: Elsevier
Start Page: 751
End Page: 759
Journal / Book Title: Lancet
Volume: 387
Issue: 10020
Copyright Statement: © Wardle et al. 2015. Open Access article distributed under the terms of CC BY.
Sponsor/Funder: University College London Hospitals NHS Foundation
Cancer Research UK
Funder's Grant Number: Programme G526
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
Colorectal Neoplasms
Correspondence as Topic
Early Detection of Cancer
Evidence-Based Medicine
Mass Screening
Middle Aged
Occult Blood
Patient Acceptance of Health Care
Reminder Systems
Social Class
State Medicine
11 Medical And Health Sciences
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine

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