Jane Wardle|Christian von Wagner|Ines Kralj?Hans|Stephen P Halloran|Samuel G. Smith|Lesley McGregor|Gemma Vart|Rosemary Howe|Julia Snowball|Graham Handley|Richard F. Logan|Sandra Rainbow|Steve Smith|Mary Thomas|Nicholas Counsell|Stephen Morris|Stephen W. Duffy|Allan Hackshaw|Sue Moss|Wendy Atkin|Rosalind Raine
Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials
University College London|University College London|King's College London|Royal Surrey County Hospital|University of Surrey|Royal Surrey NHS Foundation Trust|University College London|Queen Mary University of London|University College London|University College London|Imperial College London|Royal Surrey NHS Foundation Trust|Royal Surrey County Hospital|Gateshead Health NHS Foundation Trust|Queen Elizabeth Hospital|Nottingham University Hospitals NHS Trust|St Mark's Hospital|University Hospitals Coventry and Warwickshire NHS Trust|Hospital of St. Cross|University College London|University College London|London Cancer|University College London|Queen Mary University of London|University College London|London Cancer|Queen Mary University of London|Imperial College London|University College London
h3backgroundh3 uptake national colorectal cancer screening programme england varies socioeconomic status assessed four interventions aimed reducing gradient intention improving health benefits screening h3methodsh3 people eligible screening men women aged 6074 years across england included four clusterrandomised trials randomisation based day invitation trial compared standard information standard information plus following supplementary interventions trial 1 november 2012 supplementary leaflet summarising gist key information trial 2 march 2012 supplementary narrative leaflet describing peoples stories trial 3 june 2013 general practice endorsement programme invitation letter trial 4 julyaugust 2013 enhanced reminder letter banner reiterated screening offer socioeconomic status defined index multiple deprivation score home address primary outcome socioeconomic status gradient uptake across deprivation quintiles study registered number isrctn74121020 h3findingsh3 four trials embedded screening programme loss followup minimal less 05 trials 1 n163 525 2 n150 417 showed effects socioeconomic gradient uptake overall uptake trial 3 n265 434 showed effect socioeconomic gradient associated increased overall uptake adjusted odds ratio 107 95 ci 104110 p00001 trial 4 n168 480 significant interaction seen socioeconomic status gradient p0005 stronger effect deprived quintile adjusted 111 95 ci 104120 p0003 least deprived 100 094106 p098 overall uptake also increased 107 103111 p0001 h3interpretationh3 four evidencebased interventions enhanced reminder letter reduced socioeconomic gradient screening uptake reducing inequalities screening uptake written materials alone challenging h3fundingh3 national institute health research