Evaluation of a service intervention to improve awareness and uptake of bowel cancer screening in ethnically-diverse areas

Background: Uptake of bowel cancer screening is lowest in London, in populations of lower socio-economic status, and in particular ethnic or religious groups. Methods: We report on the evaluation of two interventions to improve uptake in an area including populations of low socioeconomic status and considerable ethnic diversity. The interventions were face-to-face health promotion on bowel cancer screening at invitees' general practice and health promotion delivered by telephone only. Nine large general practices in East London were chosen at random to offer face-to-face health promotion, and nine other large practices to offer telephone health promotion, with 24 practices of similar size as comparators. Data at practice level were analysed by Mann-Whitney-Wilcoxon tests and grouped-logistic regression. Results: There were 2034 invitees in the telephone intervention practices, 1852 in the face-to-face intervention practices and 5227 in the comparison practices. Median gFOBt kit uptake in the target population (aged 59-70) was 46.7% in the telephone practices, 43.8% in the face-to-face practices and 39.1% in the comparison practices. Significant improvements in the odds of uptake were observed following telephone intervention in both males (OR = 1.39, 95% CI = 1.20-1.61, P<0.001) and females (OR = 1.49, 95% CI = 1.29-1.73, P<0.001), while the face-to-face intervention mainly impacted uptake in males (OR = 1.23, 95% CI = 1.10-1.36), P<0.001) but did not lead to a significant increase in females (OR = 1.12, 95% CI = 0.96-1.29, P = 0.2). Conclusions: Personally delivered health promotion improved uptake of bowel cancer screening in areas of low socio-economic status and high ethnic diversity. The intervention by telephone appears to be the most effective method.