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Cited by 83Colorectal Cancer Screening and DetectionGlobal Cancer Incidence and ScreeningHealth Promotion and Cardiovascular Prevention

Strategies for increasing participation in mail-out colorectal cancer screening programs: a systematic review and meta-analysis

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Goodwin, Belinda C., Ireland, Michael J., March, Sonja, Myers, Larry, Crawford-Williams, Fiona, Chambers, Suzanne K., Aitken, Joanne F., Dunn, Jeff·2019·Systematic Reviews
DOI 10.1186/s13643-019-1170-xPMC PMC6827213
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Abstract

Background: Population mail-out bowel screening programs are a convenient, cost-effective and sensitive method of detecting colorectal cancer (CRC). Despite the increased survival rates associated with early detection of CRC, in many countries, 50% or more of eligible individuals do not participate in such programs. The current study systematically reviews interventions applied to increase fecal occult blood test (FOBT) kit return, specifically in population mail-out programs. Methods: Five electronic databases (PubMed, PsycINFO, Scopus, CINAHL, and ProQuest Dissertations and Theses) were searched for articles published before the 10th of March 2018. Studies were included if they reported the results of an intervention designed to increase the return rate of FOBT kits that had been mailed to individuals’ homes. PRISMA systematic review reporting methods were applied and each study was assessed using Cochrane’s Risk of Bias tool. Pooled effect sizes were calculated for each intervention type and the risk of bias was tested as a moderator for sensitivity analysis. Results: The review identified 53 interventions from 30 published studies from which nine distinct intervention strategy types emerged. Sensitivity analysis showed that the risk of bias marginally moderated the overall effect size. Pooled risk ratios and confidence intervals for each intervention type revealed that telephone contact RR = 1.23, 95% CI (1.08–1.40), GP endorsement RR = 1.19, 95% CI (1.10–1.29), simplified test procedures RR = 1.17, 95% CI (1.09–1.25), and advance notifications RR = 1.09, 95% CI (1.07–1.11) were effective intervention strategies with small to moderate effect sizes. Studies with a high risk of bias were removed and pooled effects remained relatively unchanged. Conclusions: Interventions that combine program-level changes incorporating the issue of advance notification and alternative screening tools with the involvement of primary health professionals through endorsement letters and telephone contact should lead to increases in kit return in mail-out CRC screening programs. Systematic review registration: This review is registered with PROSPERO; registration number CRD42017064652

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  • In CRC home testing, print materials (e.g., educational booklets) or narrative information leaflets with the test kit have sometimes had an adverse effect.

    “In CRC home testing, print materials (e.g., educational booklets) or narrative information leaflets with the test kit have sometimes had an adverse effect [40].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [40]

    The Results (Print materials) report that narrative leaflets were associated with very small decreases in participation, and the Discussion says they negatively affected kit return in two studies. The Results also say that none of the five interventions using CRC information booklets significantly affected uptake; they do not establish an adverse effect for booklets. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Excessive information may be burdening, especially if it is not clearly from a trusted source such as a local health clinic.

    “This suggests that excessive information may be burdening -especially if it is not clearly from a trusted source, e.g., a local health clinic [40].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [40]

    The Discussion (page unavailable) says that added narrative information may burden and deter participation in mail-out colorectal screening, and that the source of printed content appeared to matter more than its content. It also describes GPs as trusted sources of medical advice. It does not establish that excessive information is especially burdensome when its source is unclear, or specifically assess a local health clinic as the source. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Some strategies such as additional print materials might reduce effectiveness when combined with other interventions if not carefully designed.

    “However, caution is advisable since some strategies such as additional print materials (which may have an adverse effect when used alone as well [40]) might reduce effectiveness when combined with other interventions [62].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [40]

    The Results (Print materials) report small decreases in participation when narrative leaflets were added to screening kits, and the Discussion cautions that excessive information may deter participation. But the cited paper does not show that print materials reduce the effectiveness of other interventions when combined with them; its Policy and practical implications section says the additive benefits of combined approaches have not been empirically tested. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • A simplified or enhanced testing procedure (e.g., removing dietary restrictions or including collection papers) yielded positive results.

    “Furthermore, a simplified or enhanced testing procedure (e.g., removing dietary restrictions or including collection papers) yielded positive results [40].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [40]

    The Results (Meta-analysis) report a positive pooled effect for simplified test procedures, and the Results (Simplified test procedures) report positive effects in two of three interventions that removed dietary restrictions. But that section says interventions using feces collection paper did not have significant positive effects; the Discussion likewise says collection papers were generally not effective. Page numbers are not provided in our copy. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • According to a meta-analysis, advance notification letters have had a positive effect on uptake.

    “According to a meta-analysis, advance notification letters have also had a positive effect on uptake [40].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [40]

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Sorted by citations

Authors
Goodwin, B. C., Ireland, M. J., March, S., Myers, L., Crawford-Williams, F., Chambers, S. K., Aitken, J. F., & Dunn, J.
Affiliations
  • University of Southern Queensland (AU)
  • University of Technology Sydney (AU)
  • Griffith University (AU)
Corresponding author
Goodwin, Belinda C.
ORCID
Venue
Systematic Reviews
Publisher
Springer Science and Business Media LLC
Published
2019-11-04
Volume
8
Issue
1
Pages
257-257
ISSN
2046-4053 (ISSN-L)
DOI
10.1186/s13643-019-1170-x
PMC
PMC6827213
OpenAlex
W2986962903
Cited by
83
References
1
Citations by year
2026: 12 · 2025: 13 · 2024: 13 · 2023: 19 · 2022: 9 · 2021: 9 · 2020: 7 · 2019: 1
FWCI
0.62
Type
journal article
Language
en
Open access
Licence
Locations
  • Systematic Reviews (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Griffith Research Online (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • University of Southern Queensland (N/A)
  • Cancer Council Queensland (N/A)
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, fecal occult blood test, screening uptake, telephone contact, advance notification, intervention effectiveness
MeSH terms
Humans, Occult Blood, Patient Compliance, Postal Service, Colorectal Neoplasms, Early Detection of Cancer

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