The effect and psychological mediators of a redesigned invitation letter to increase bowel cancer screening intention and likelihood: A randomised controlled experiment

Katelyn Collins; Michael Ireland; Nicole Perry; Mark Jenkins; Jennifer G McIntosh; Eleonora Feletto; Nancy N Baxter; Belinda Goodwin

doi:10.1016/j.pec.2025.109240

The effect and psychological mediators of a redesigned invitation letter to increase bowel cancer screening intention and likelihood: A randomised controlled experiment

Patient Educ Couns. 2025 Oct:139:109240. doi: 10.1016/j.pec.2025.109240. Epub 2025 Jul 1.

Authors

Katelyn Collins¹, Michael Ireland², Nicole Perry³, Mark Jenkins⁴, Jennifer G McIntosh⁵, Eleonora Feletto⁶, Nancy N Baxter⁷, Belinda Goodwin⁸

Affiliations

¹ Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia; School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia. Electronic address: u1160643@umail.usq.edu.au.
² School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia; Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia.
³ Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia; School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Queensland, Australia.
⁴ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia; School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia.
⁵ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia; Department of General Practice and Primary Care, University of Melbourne, Melbourne, Victoria, Australia.
⁶ The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, New South Wales, Australia.
⁷ Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
⁸ Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia; Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia.

PMID: 40614340
DOI: 10.1016/j.pec.2025.109240

Abstract

Background: Participation in the Australian National Bowel Cancer Screening Program (NBCSP) is low. Modifying the invitation letters sent with home bowel cancer screening kits may increase participation.

Objectives: This study compared current and modified versions of the NBCSP invitation letter to assess impact on intention to screen and perceived likelihood of screening and the role of screening barriers, enablers, and recipient characteristics.

Methods: In an online survey, 700 Australians aged 50-74 years were randomly assigned to view either the current NBCSP invitation letter or a redesigned version featuring a deadline, a prompt to place the kit somewhere visible, and simple pictorial instructions. Intention to screen for bowel cancer, perceived likelihood of screening, and screening barriers and enablers were measured before and after letter exposure. Mixed ANOVA and ANCOVA were used to assess pre-post changes in screening outcome variables, the mediating role of changes in screening barriers and enablers, and the moderating effect of age, gender, education, and screening history.

Results: Compared to the control letter, the redesigned letter was associated with an absolute increase in perceived screening likelihood of 2.8 %, F(1, 698) = 5.77, p = .017). This effect was mediated by increased screening benefits (b =.03, p = .019), self-efficacy (b =.03, p = .024), and planning to use the kit (b =.05, p = .008). Decreased perceived difficulty and avoidance mediated the effect of the resigned letter only among those who had never screened before (b = -0.04, p = .017), and males (b = 0.03, p = .045), respectively.

Conclusion: Invitation letters that highlight screening benefits and provide simple, practical guidance to support planning and self-efficacy may increase recipients' screening likelihood. Messaging reducing difficulty and avoidance barriers may be most effective for males and those who have not screened previously.

Keywords: Cancer screening; Colorectal cancer; Faecal immunochemical blood test; Mailed invitations; Psycho-oncology.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Australia
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / prevention & control
Colorectal Neoplasms* / psychology
Correspondence as Topic*
Early Detection of Cancer* / psychology
Female
Humans
Intention*
Male
Mass Screening* / psychology
Middle Aged
Patient Acceptance of Health Care* / psychology
Surveys and Questionnaires