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Cluster randomized controlled trial of volitional and motivational interventions to improve bowel cancer screening uptake: A population-level study

Author

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  • Wilding, Sarah
  • Tsipa, Anastasia
  • Branley-Bell, Dawn
  • Greenwood, Darren C.
  • Vargas-Palacios, Armando
  • Yaziji, Nahel
  • Addison, Caroline
  • Kelly, Phil
  • Day, Fiona
  • Horsfall, Kate
  • Conner, Mark
  • O'Connor, Daryl B.

Abstract

Objectives. Colorectal cancer (CRC) is a leading cause of cancer death worldwide, although effective uptake of bowel cancer screening is below 60% in England. This trial investigated the influence of volitional and motivational interventions and their combination on increasing guaiac fecal occult blood testing (gFOBT) screening uptake. Method. In total, 34,633 participants were recruited (via North-East of England bowel cancer screening hub) into a 2×2 factorial cluster randomized controlled trial. Social norm-based motivational intervention (SNA); Implementation intention-based Volitional Help Sheet (VHS); Combined intervention (SNA+VHS); Treatment as usual control. Screening rate (gFOBT kit return rate within 8 weeks of invitation) was the primary outcome. Results. Screening kits were returned by 60% of participants (N=20,847/34,633). A substantial imbalance was observed in participant characteristics, participants in the combined intervention group were younger and more likely to be first time invitees. Adjusted analyses found insufficient evidence that any of the interventions were different to control (Combined: OR = 1.18, 95% CI 0.97-1.44; SNA alone: OR=0.93; 95% CI: 0.76-1.15; VHS alone OR= 0.88; 95% CI: 0.75-1.03). Subgroup analyses demonstrated a significant beneficial effect of the combined intervention in the youngest age group compared to control (OR = 1.27; 95% CI: 1.05-1.54). Conclusions. The study did not support any benefit of either VHS or SNA interventions alone on bowel cancer screening uptake. The combined SNA+VHS intervention was significantly different from control only in the youngest age group in adjusted analyses. However, the magnitude of effect in the youngest age group suggests that further testing of VHS plus SNA interventions in carefully targeted populations may be warranted.

Suggested Citation

  • Wilding, Sarah & Tsipa, Anastasia & Branley-Bell, Dawn & Greenwood, Darren C. & Vargas-Palacios, Armando & Yaziji, Nahel & Addison, Caroline & Kelly, Phil & Day, Fiona & Horsfall, Kate & Conner, Mark , 2020. "Cluster randomized controlled trial of volitional and motivational interventions to improve bowel cancer screening uptake: A population-level study," Social Science & Medicine, Elsevier, vol. 265(C).
    • Handle: RePEc:eee:socmed:v:265:y:2020:i:c:s0277953620307152
    DOI: 10.1016/j.socscimed.2020.113496
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    References listed on IDEAS

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    1. Miller, Brittany C. & Bowers, Jennifer M. & Payne, Jackelyn B. & Moyer, Anne, 2019. "Barriers to mammography screening among racial and ethnic minority women," Social Science & Medicine, Elsevier, vol. 239(C).
    2. Solmi, Francesca & Von Wagner, Christian & Kobayashi, Lindsay C. & Raine, Rosalind & Wardle, Jane & Morris, Stephen, 2015. "Decomposing socio-economic inequality in colorectal cancer screening uptake in England," Social Science & Medicine, Elsevier, vol. 134(C), pages 76-86.
    3. Claxton, Karl, 1999. "The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies," Journal of Health Economics, Elsevier, vol. 18(3), pages 341-364, June.
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    1. Wilding, Sarah & Prudenzi, Arianna & Conner, Mark & O'Connor, Daryl B., 2022. "Do reasoned action approach variables mediate relationships between demographics and cervical cancer screening intentions or behaviour? An online study of women from the UK," Social Science & Medicine, Elsevier, vol. 313(C).
    2. Wilding, Sarah & Wighton, Sarah & West, Robert & Conner, Mark & O'Connor, Daryl B., 2023. "A randomised controlled trial of volitional and motivational interventions to improve cervical cancer screening uptake," Social Science & Medicine, Elsevier, vol. 322(C).

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