Testing behavioral interventions to optimize participation in a population-based colorectal cancer screening program in Catalonia, Spain
Open accessAbstract
The aim of the study was to measure the effect of three cost-neutral behavioral interventions on participation compared to the standard invitation letter in a population-based colorectal cancer screening program in 2014. For that purpose, a four-arm randomized field trial was conducted among 5077 individuals aged 50 to 69 years. Over an 8-week period, each week was randomly allocated to the intervention or the control conditions. Individuals assigned to the intervention conditions additionally received a prompt to write down the date to pick up the screening test in a pharmacy. Two of the three intervention groups also included an additional paragraph in the invitation letter on either: 1) the high proportion of individuals participating regularly (social norms condition) or 2) the importance of regular participation (benefit condition). We measured screening participation before and after receiving a reminder letter six weeks after the screening invitation. An overall 8.0 percentage point increase in CRC screening was achieved as a direct result of receiving a reminder letter; however none of the intervention strategies influenced participation. The only significant difference was found for newly invited individuals. There, participation rates decreased from 34.9% to 24.2% when the invitation mailing mentioned the importance of regular participation (OR: 0.60; 95% CI: 0.38-0.95). While none of the intervention strategies improved participation rates we found that praising th…
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Highlighting benefits of screening had adverse effects in Spain for newly invited individuals, decreasing participation by 10.7%.
“Highlighting benefits of screening had adverse effects in Spain for newly invited individuals decreasing the participation by 10.7% [58].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [58]
In Spain, a prompt in the reminder letter to write down the date for the CRC test resulted in 8%pt increase in CRC screening.
“In Spain, a prompt in the reminder letter to write down the date for the CRC test resulted in 8%pt increase in CRC screening [58].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [58]
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Self-citation
- Authors
- Stoffel, S., Benito, L., Milà, N., Travier, N., Binefa, G., Vidal, C., Espinosa, J., Moreno, V., & Garcia, M.
- Affiliations
- University College London (GB)
- Institut d'Investigació Biomédica de Bellvitge (ES)
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 119
- Pages
- 58-62
- ISSN
- 0091-7435 (ISSN-L)
- OpenAlex
- W2908095833
- Cited by
- 15
- References
- 30
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 3
- FWCI
- 0.28
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion, other-oa)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by-nc-nd)
- Funders
- Carlos III Health Institute
- European Regional Development Fund (PI05/0942)
- Government of Catalonia (2017SGR1283)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- colorectal cancer screening, screening uptake, behavioral interventions, reminder letters, social norms, perceived benefits of screening, pharmacy-based screening, population-based screening program, health behavior change
- MeSH terms
- Aged, Female, Humans, Male, Mass Screening, Middle Aged, Occult Blood, Patient Participation, Postal Service, Spain, Colorectal Neoplasms, Reminder Systems, Early Detection of Cancer
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