Author

R. Kerrison

Abstract

In March 2013, NHS England extended its national bowel cancer screening programme to include once-only flexible sigmoidoscopy ('bowel scope') screening for men and women aged 55. Since roll-out of the programme began, uptake has been low and inequitable, with people living in the most deprived areas being the least likely to take part in screening. This thesis examines uptake at St Mark's Hospital, a centre which serves a socioeconomically diverse population with below average uptake, and goes on to describe the development and evaluation of an intervention targeted at those who do not participate. Study 1 identifies and describes possible targets for intervention. The results of the study informed the design of a self-referral reminder letter and theory-based information leaflet to be sent to individuals who did not attend bowel scope screening (BSS) within one year of their original invitation. Study 2 describes a test of the intervention's feasibility, with results demonstrating its potential to increase BSS uptake. Study 3 examines the effectiveness of the reminder letter and theory-based leaflet by comparing uptake against appropriate controls, namely: no reminder or the designed reminder letter sent with the standard information booklet used by the National Health Service. The results of the randomised controlled trial (RCT) demonstrate that uptake was significantly higher among the two groups receiving the reminder, with the group receiving the theory-based leaflet showing the highest rate of uptake. In Study 4, the materials were re-sent to those who had not attended BSS within 24 months of their initial invitation. The results of this extension to the RCT corroborate the outcome of the first reminder. This series of studies demonstrates the usefulness of additional reminders in the BSS programme, which is discussed alongside other implications for policy in the discussion of this thesis.