A trial to increase participation in the National Bowel Cancer Screening Program by eligible Indigenous clients of participating primary health care centres that receive either an intensive model of support or a low intensity model of support in offering screening.

Intervention Arm A (low intensity support) - Primary health care centres in this arm are offered a low intensity model of support to prepare them to offer the National Bowel Cancer Screening Program bowel screening kit to their eligible clients (aged 50-74). This support includes access to an online training module for health centre staff about bowel cancer and bowel cancer screening and other resources to assist them to deliver the program to their clients. When eligible clients attend the health centre they will be invited to screen and receive a bowel screening kit as part of the Alternative Pathway. The on-line training module includes the following topics: About bowel cancer and bowel cancer screening; Risk factors for bowel cancer; Bowel cancer treatment; Incidence, survival and screening participation rates; About the National Bowel Cancer Screening Program; About the Alternative Pathway; Talking about bowel screening with your Indigenous clients (clinical and social aspects); Assessing suitability for screening; Understanding test results; General Practitioner assessment; Colonoscopy; Risks and benefits of screening. The online training module will take health professionals about one hour to complete. It was designed specifically for the pilot to relate directly to the context of primary health care centres and health professionals providing services to Indigenous clients in the eligible age group. It includes the use of animations, a music video, and with voiceovers by Aboriginal and Torres Strait Islander actors (two male, one female). Short quizzes (three to six questions each) test participant knowledge and learning throughout the module. Designed primarily for Indigenous Health Workers, the resources can be used by other health professionals. Other resources developed specifically for this project and provided as part of the low intensity support model include: - A manual for implementation: 'The Alternative Pathway in your Health Centre' provides primary health care centre managers and staff with the information to prepare for and deliver the Alternative Pathway, such as how the Alternative pathway differs from the usual pathway for accessing the National Bowel Cancer Screening Program; what needs to be done before health centres will be able to offer the Alternative Pathway to their eligible Indigenous clients; requirements for managing test kits (both before and after samples are taken); obtaining client consent and providing client information through the secure online Participant Details (Health Centre Initiated) form; receiving client results electronically or on paper from the Program’s pathology provider; Program follow-up procedures for individuals who receive a kit but do not complete it, or who receive a positive result and do not proceed with a General Practitioner assessment and/or colonoscopy if referred; requirements for General Practitioner assessments; access to colonoscopy and supporting clients who are referred for colonoscopy. It includes A Checklist for Talking about Bowel Screening with your clients; flowcharts for the National Bowel Cancer Screening Program and the Alternative Pathway; templates to support implementation planning (based on the Consolidated Framework for Implementation Research, https://cfirguide.org); descriptions of the Alternative Pathway resources for health professionals and for clients; key contacts. - Motivational poster (‘Bowel screening saves lives’) to prompt health professionals to talk to their clients about bowel screening - Information sheets: one for Indigenous Health Workers and one for General Practitioners. Each sheet presents information about why bowel screening is important for Indigenous people, and addresses specific barriers that were identified in previous studies or consultations as affecting each of these two professional groups. - A flipchart with information presented visually or in plain language on one side of the flipchart, with text for presentation by an Indigenous Health Worker on the other side. The flip chart covers key information for Indigenous adults about bowel cancer, bowel screening, and how to do the test. - A poster for display in the health centre ‘Don’t delay, do a bowel test today’, that encourages eligible patients to talk to their doctor or health worker about screening. - A brochure with basic information about bowel screening, ‘Bowel screening: It’s not shame, it’s a way of life’ and space for an appointment time to be written on the back. - Access to support lines: * The National Bowel Cancer Screening Program Information Line (part of the Program’s Business as Usual support services). * The National Bowel Cancer Screening Program Health Provider Hotline (to the Program’s pathology provider, also part of the Program’s Business as Usual support. * A National Pilot Support Officer within the Department of Human Services who will assist with interaction between the Program Register and participating health centres. * Menzies School of Health Research Site Support, a helpline to Menzies Project Team staff who will provide responses to queries relating specifically to the implementation and evaluation of the Alternative Pathway, training, and any questions related to the research aspects of the Pilot, and refer questions about the national Program, Register or pathology to the other support lines as relevant. Fidelity of training delivery is ensured by: - all training materials have been endorsed by the Department of Health as adhering to the requirements of the National Bowel Cancer Screening Program (see also below under Comparator/Control for measures to ensure fidelity in face to face workshops and in-services) - all participating health centres will have access to the same online training module, implementation manual and other resources provided for health centres in Arm A. Fidelity and adherence in the delivery of the Alternative Pathway at health centre level is ensured through: - all participating primary health care centres must complete a Quality and Safety Checklist to a satisfactory standard before the health centre will be provided with National Bowel Cancer Screening Program kits. The Quality and Safety Checklist covers potential risks identified by the National Bowel Cancer Screening Program, and during previous research, that health centres will need to manage, such as safe storage of screening kits, staff skill levels, timely access to colonoscopy, privacy and confidentiality issues. Health centres complete the Checklist to demonstrate how they will manage the risks. Once the Quality and Safety Checklist is submitted, it will be assessed by members of the Menzies Project Team and Department of Health representatives for the National Bowel Cancer Screening Program. As a quality and safety measure, health centres may resubmit if initial efforts are not satisfactory. Once completed to a satisfactory level, health centres will be able to invite eligible patients to screen, assess their screening suitability, and offer screening kits as part of the Alternative Pathway. - use of a secure Online Form for all participating health centre staff to report standardised details about their assessment of health centre clients for screening. Additional support components offered to Arm B will be offered to Arm A at the end of the Pilot: Health centres in Arm B (intensive model of support) will receive additional support components (described in detail below) prior to beginning to offer the Alternative Pathway to their eligible Indigenous clients. If effective, these additional components of support will be made available to health centres in Arm A following the end of the 12 month period in which health centres give out kits to their clients.