Equity-focused interventions to increase colorectal cancer screening

Key strategies to increase colorectal cancer screening rates

There are three key strategies to improve overall colorectal cancer screening rates. Raising awareness about screening services and why they’re important increases community demand by encouraging more people to seek out screening. Ensuring services are easily available when needed increases community access. And targeted training for healthcare professionals increases provider delivery.

Interventions to increase community demand

icon phone and letterParticipant reminders such as letters, postcards and phone calls help increase screening participation. Follow-up information on the benefits of screening or help with scheduling appointments can also improve uptake. Direct communication from a healthcare provider or other personalized reminders are particularly effective among low-income populations.

Multi-component interventions

Interventions involving more than one approach have been found to be more effective among all populations than single-component interventions—especially when approaches from different strategy areas are combined. For example, combining participant reminders to increase demand with direct mailing of test kits to increase access can lead to higher screening rates.

icon brochureSmall media, such as videos and printed materials (e.g., handouts, letters, brochures), are more effective than mass media (e.g., TV, radio, billboards, magazine ads) at encouraging all populations to get screened. These materials can be tailored to specific populations through translation, culturally appropriate customization or the use of plain language.

icon of two people talkingEducation is effective across all population groups, especially when delivered in one-on-one settings—for example, a healthcare provider explaining in simple terms the benefits of screening to a participant or helping someone navigate the health system.

Group education may also be effective among low-income, visible minority and immigrant populations. Trusted lay health promoters from the community can deliver group education from a shared cultural perspective, which can increase awareness and reduce misconceptions, leading to higher screening uptake.

Interventions to increase community access

icon helperReducing the structural barriers that make it hard to access screening services is essential. These may include confusing administrative procedures, scheduling challenges, lack of convenient clinics or language barriers. Ensuring materials and services are available in multiple languages or distributing them through mobile clinics can also help increase access to screening.

icon letter in envelopeMailing fecal test kits directly to participants is one way to reduce barriers—people who receive kits are twice as likely to complete the test than those who receive a letter alone. Making it possible for people to collect samples in their own homes on their own schedules also reduces in-person interactions with healthcare providers, which is especially useful during times of high pressure on the health system—such as the COVID-19 pandemic.

icon coinsIn the U.S., studies have found that reducing out-of-pocket costs for participants by waiving fees or offering no-cost screening can improve uptake in certain groups, including low-income, visible minority, immigrant, and remote and rural populations. While direct medical fees are less of a concern in Canada, reducing associated costs, such as transportation, parking or childcare, could still be effective.

Interventions to increase provider delivery

icon computerThe use of reminder and recall systems, such as electronic medical records or emails, helps providers keep track of when participants are due (or overdue) for screening. When combined with a personal referral and follow-up, this intervention is highly effective among all population groups.

icon teacherProviding education and training for healthcare providers on how to offer screening services to different population groups is key. Assessment and feedback tools can help providers evaluate their performance and make improvements in the way they deliver screening services. These interventions are especially effective for providers serving low-income, rural and remote or visible minority populations.