Behavior Change, Colorectal Cancer
Conditions
Keywords
colorectal cancer, cancer screening, behavioral insights, communications
Brief summary
Colorectal cancer (CRC) is one of the leading causes of death in Croatia. An average of 3600 cases are diagnosed and an average of 2100 people die from the disease every year. Since 2007, Croatia has invited every man and woman aged 50-74 to participate in the home testing screening programme every two years. Currently only around 36% of the invited request the test-kit and 25% complete the home testing procedure, far below the target of 40-60%. The Croatian Institute of Public Health with technical support from World Health Organization (WHO) Regional Office for Europe is undertaking a mixed-methods research study with the aim to increase the completion of colorectal cancer home testing and improve our knowledge of the barriers and drivers to do so. The study has a quantitative and a qualitative component: 1. Quantitative: testing the introduction of a reminder letter to encourage people to respond to the initial invite to participate in the CRC home test program and test which elements of a reminder letter improve response rates. The quantitative component consists of a four-arm reminder letter randomized controlled trial (RCT) comparing no letter, standard letter, behaviorally informed letter, and behaviorally informed letter sent with a home testing kit to investigate the effectiveness of reminders in increasing uptake of home-testing for colorectal cancer. Recruitment and data collection for the reminder letter trial will be conducted utilizing the routine screening process and routinely collected screening data. 2. Qualitative: conducting in-depth interviews with people from the target population who did or did not respond to the CRC invite letter and reminder to better understand the barriers and drivers to participation. The qualitative component consists of 24 in-depth interviews (IDIs) conducted with members of the target population to identify barriers and drivers to completing colorectal cancer screening home-testing. Data collection for IDIs will be face-to-face, using discussion guides, and will be audio recorded. The audio-recordings will then be analyzed using a rapid analysis approach based on by the modified Capability-Opportunity-Motivation-Behavior (COM-B) framework.
Interventions
BEHAVIORALStandard letter
A reminder letter to encourage recipients to order the colorectal cancer home testing kit, based on the current invite letter.
BEHAVIORALBehaviorally informed letter
A reminder letter to encourage recipients to order the colorectal cancer home testing kit, with incorporates severally behaviorally informed components, including an active choice prompt, social norm, call to action, chunking and simplification.
BEHAVIORALHome testing colorectal cancer kit
The home testing kit is included with the reminder letter, instead of the usual process of responding to the letter to order the kit
Sponsors
Croatian Institute of Public Health
Andrija Štampar School of Public Health
Veerle Snijders
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
SINGLE (Subject)
Intervention model description
Participants will be randomized to either control (no reminder screening invitation) or one of three treatments (standard reminder letter, behaviorally informed reminder letter, behaviorally informed letter with home testing kit included).
Eligibility
Sex/Gender
ALL
Age
50 Years to 74 Years
Healthy volunteers
Yes
Inclusion criteria
* eligible to participate in the national colorectal cancer screening programme * live in a study location (Split-Dalmatia or Zagreb City counties) * did not respond to the cancer screening invite letter
Exclusion criteria
* participated in the colorectal screening programme in the last 24 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Home test kit ordered | 5 weeks | Did the participant order the colorectal cancer home testing kit? Routinely collected data. |
| Completed colorectal cancer screening | 5 weeks | Did the participant complete the home testing kit and return it to the health authority? Routinely collected data. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Opted out | 5 weeks | Did the participant actively opt out of participating in the screening program? Routinely collected data. |
| Qualitative feedback | 10 weeks | Qualitative feedback on the intervention arms and colorectal cancer screening experience. Collected through 24 semi-structured interviews. |
Countries
Croatia
Contacts
Primary ContactVeerle Snijders
Backup ContactTiina Likki
Outcome results
None listed