by Justin Wilkes - Director at Spink
Colorectal cancer (CRC or bowel cancer) is the most common type of digestive cancer in Europe, with 68 cases per 100,000 population but with the introduction of organised and effective population based screening programmes, in some countries, there has been a significant reduction in mortality rates as cancers are detected earlier and thus more rapidly effectively treated.
However, despite the evidence that screening saves lives, there are still large sections of the population that do not participate in national CRC screening programmes. In the UK, for example, there are, according to United European Gastroenterology, approximately 45% of the target population who do not participate in the national screening programme. There are a wide range of complex social, cultural, emotional and contextual factors that affect people’s willingness to participate, with the following being the primary causes:
- Men are much less likely to participate than women
- Fear of a negative outcome may deter people from participating
- Overwhelming people with too much information may be counter-productive
- A misconception that the test is not applicable if you don’t have any apparent symptoms of bowel cancer or the individuals’ perceived risk is low
- Concerns around the practicalities and cleanliness of the test
- Lower socioeconomic groups and low health literacy impact upon uptake
There have been a number of studies carried out, particularly by the Research Department of Behavioural Science and Health at University College London, into how differing types of communications inviting individuals to participate in screening can impact uptake. The ASCEND study in the UK for example assessed four interventions aimed at reducing poor uptake amongst deprived groups. The most effective intervention was a reminder letter with a simplified message and a personalised banner at the top and a risk emphasis banner at the bottom. This approach had a statistically significant impact upon uptake amongst the most economically deprived group. Another recent study by the UCL team indicates an increase in uptake of non-participants if reminders are sent and an even greater uptake if reminders are sent with localised information – especially amongst men vs women. Previous attempts to maximise attendance through emphasising the benefits of screening have been replaced by efforts to enable individuals to make an informed choice, through the provision of comprehensive information and whilst there is some evidence to show that this increases uptake in certain groups, for individuals to make a truly informed decision regarding screening, it is important that they not only understand the potential harms and benefits but also the purpose of screening. This could prove to be over-whelming for some and requires good levels of literacy.
The results from such studies have provided some indication of improvements in participation rates but there is still more evidence required and the only true outcome is that a one size fits all approach does not work in engaging with non-participants. This corresponds to a consensus amongst CRC medical experts and patient organisation representatives meeting at UEG Week 2014, who agreed that communications encouraging participation in screening programmes should be simple, emotive and factual but with a tone that is applicable to specific target groups of the population.
A further consideration in the UK, particularly when addressing the next generation of screenees, is whether it is still appropriate for health authorities and bodies to be communicating with the target population using NHS labelled materials and channels that look and feel out-dated and, in my opinion, are out of touch with a modern generation. I would advocate greater use of social media communications and the use of tone and imagery that were more relevant to a modern society. I also believe that the NHS should look more closely at fmcg marketing and communications tactics and take an approach that is more engaging with the consumer and taps into the modern psyche. The power of ‘word-of-mouth’ and viral campaigns in the fmcg world is considerable and not only engages with the end user but creates brand loyalty and referral. It is this type of communications environment that is required to help improve engagement with a wider audience and improve uptake of and adherence to cancer screening.
What if brands like Carlsberg, Durex or Pepsi did screening? How different the situation might be?