Abstract
BackgroundNew Zealand’s Bowel Screening Pilot (BSP) used a mailed invitation to return a faecal immunochemical test. As a pilot it offered opportunities to test interventions for reducing ethnic inequities in colorectal cancer screening prior to nationwide programme introduction. Small media interventions (e.g. educational material and DVDs) have been used at both community and participant level to improve uptake. We tested whether a DVD originally produced to raise community awareness among the Māori population would have a positive impact on participation and reduce the proportion of incorrectly performed tests (spoiled kits) if mailed out with the usual reminder letter.MethodsThe study was a parallel groups pseudo-randomised controlled trial. Over 12 months, all Māori and Pacific ethnicity non-responders four weeks after being mailed the test kit were allocated on alternate weeks to be sent, or not, the DVD intervention with the usual reminder letter. The objective was to determine changes in participation and spoiled kit rates in each ethnic group, determined three months from the date the reminder letter was sent. Participants and those recording the outcomes (receipt of a spoiled or non-spoiled test kit) were blinded to group assignment.Results2333 Māori and 2938 Pacific people participated (11 withdrew). Those who were sent the DVD (1029 Māori and 1359 Pacific) were less likely to participate in screening than those who were not (1304 Māori and 1579 Pacific). Screening participation was reduced by 12.3% (95% CI 9.1–15.5%) in Māori (13.6% versus 25.9%) and 8.3% (95% CI 5.8–10.8%) in Pacific (10.1% versus 18.4%). However, spoiled kit rates (first return) were significantly higher among those not sent the DVD (33.1% versus 12.4% in Māori and 42.1% versus 21.9% in Pacific).ConclusionThe DVD sent with the reminder letter to BSP non-responders reduced screening participation to an extent that more than offset the lower rate of spoiled kits.Trial registrationAustralia and New Zealand Clinical Trials Registry ACTRN12612001259831. Registered 30 November 2013.
Highlights
New Zealand’s Bowel Screening Pilot (BSP) used a mailed invitation to return a faecal immunochemical test
The Fleiss test for homogeneity of the risk difference rejected the null hypothesis (p = 0.043) which demonstrates that there was a significantly stronger absolute reduction in participation associated with being sent a Digital Video Disc (DVD) in Māori that was more than should be expected by chance
In a non-prespecified analysis it heterogeneity was detected between Māori males and females in kit return rates (p = 0.035); this was of borderline significance for Pacific (p = 0.075), with a stronger negative effect on participation observed in males than females
Summary
New Zealand’s Bowel Screening Pilot (BSP) used a mailed invitation to return a faecal immunochemical test. As a pilot it offered opportunities to test interventions for reducing ethnic inequities in colorectal cancer screening prior to nationwide programme introduction. We tested whether a DVD originally produced to raise community awareness among the Māori population would have a positive impact on participation and reduce the proportion of incorrectly performed tests (spoiled kits) if mailed out with the usual reminder letter. Waitematā DHB conducted a pilot of a Bowel Screening programme (BSP) from 2012 to 2017 to inform the potential introduction of an organised colorectal cancer screening programme in NZ [1]. The pilot pathway comprised a pre-invitation letter, mailed self-test kit four weeks later, self-test completion, and return of results (via the participant’s general practitioner if positive). For Māori, Pacific and Asian ethnicity invitees, a phone call follow-up was made concurrently with the reminder letter
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