Optimising invitation and advance notification letters to increase bowel cancer screening participation: A qualitative analysis

Objectives: To explore how letters distributed in population bowel cancer screening programmes could be modified to increase bowel cancer screening uptake, from the perspective of screening invitees.

Methods: Sixty-three people aged 48–74 years discussed their preferences regarding letter design and content during semi-structured interviews aided by various example letters designed to notify of, or invite participants to, the Australian National Bowel Cancer Screening Programme (NBCSP). Deductive thematic analysis, informed by the Integrated Screening Action Model (I-SAM), was used to interpret participant feedback and provide recommendations for improvements to the letters in alignment with the theoretical stages of bowel cancer screening behaviour (engaging, deciding, and completing the screening kit).

Results: Participants generally agreed that effective letters should feature a clear, eye-catching design to enhance initial engagement. Messages targeting emotional barriers and content tailored to prior screening history were seen as crucial to drive screening decision-making. Finally, step-by-step instructions, deadlines, and reminders were identified as facilitators of kit completion, bridging the gap between intention and action.

Conclusions: The findings of this study align with the I-SAM framework for understanding the progression of screening behaviours and highlight key design elements that can enhance the effectiveness of bowel cancer screening invitations. The design and messaging within screening letters has the potential to address common concerns and encourage screening participation.

Practice implications: The simplification of letter design, and integration of tailored messaging strategies, simple kit instructions, reminders, and deadlines could boost engagement and help bridge the intention-behaviour gap, driving increased screening participation.