Co-Designing Planning Interventions to Facilitate Participation in Mail-Out Bowel Cancer Screening

Abstract Background Population mail-out bowel cancer screening programs save lives through prevention and early detection; however, their effectiveness is constrained by low participation rates. Most non-screeners intend to screen but fail to do so, often procrastinating and forgetting to complete the screening kit. This study aimed to co-design interventions to increase screening participation in the Australian National Bowel Cancer Screening Program with kit recipients. Methods Studies were informed by the Health Action Process Approach to behaviour change, and included three semi-structured interviews, and one online cross-sectional survey, all conducted between August 2021 and December 2022. Logistic regression of survey data was used to analyse strategies used to participate in bowel cancer screening. All three semi-structured interviews were analysed using the framework approach of codebook thematic analysis to describe consumers’ preferences on strategies and to develop interventions to improve bowel screening participation. Results Interview participants who returned their kit shared their effective planning strategies—such as putting the kit in a visible place or by the toilet, planning a time at home to complete the kit, and using reminders. Survey participants who reported using such strategies were more likely to have completed their screening kit when compared to those who did not report using planning strategies. Finally, interview participants who intended to use their kits—but did not—worked with researchers to adapt these strategies into interventions to facilitate screening participation. Interventions included providing a prompt to place the kit—or a sticker—near the toilet as a reminder, a deadline for kit return, the option to sign up for reminders, a bag to store the sample in the fridge, and gloves for sample collection. Conclusions These novel, consumer-centred interventions that are built upon the needs and experience of screening invitees provide promising solutions for improving participation in population bowel cancer screening.