Implementation Strategies for Interventions Aiming to Increase Participation in Mail-Out Bowel Cancer Screening Programs: A Realist Review

Larry Myers; Belinda Goodwin; Nicholas Ralph; Oscar Castro; Sonja March

doi:10.3389/fonc.2020.543732

Implementation Strategies for Interventions Aiming to Increase Participation in Mail-Out Bowel Cancer Screening Programs: A Realist Review

Front Oncol. 2020 Sep 29:10:543732. doi: 10.3389/fonc.2020.543732. eCollection 2020.

Authors

Larry Myers^{1

2}, Belinda Goodwin^{2

3}, Nicholas Ralph^{3

4

5}, Oscar Castro⁶, Sonja March^{1

2}

Affiliations

¹ Centre for Health, Informatics, and Economic Research, University of Southern Queensland, Springfield Central, QLD, Australia.
² School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia.
³ Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.
⁴ School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia.
⁵ Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
⁶ Physically Active Lifestyles Research Group, Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.

Abstract

Background: Bowel cancer is the third most commonly diagnosed cancer and the third most common cause of cancer-related death, with 1,849,518 new cases of bowel diagnosed and 880,792 deaths reported globally in 2018 alone. Survival can be improved through early detection via national mail-out bowel cancer screening programs; however, participation remains low in many countries. Behavior change is therefore required to increase participation. This realist review aims to (a) identify the behavior change techniques (BCTs) used in each intervention, (b) understand the mechanisms of action (MoAs) responsible for the BCT effectiveness, and (c) apply a behavior change model to inform how MoAs can be combined to increase screening participation. Methods: We systematically reviewed the literature for interventions aiming to increase participation in mail-out bowel cancer screening. We used a four-stage realist synthesis approach whereby (1) interventions were extracted from each study; (2) BCTs applied in each intervention were identified and coded using the BCT Taxonomy-v1; (3) the Theory and Techniques Tool was used to link BCTs to their MoA; and (4) BCTs and MoAs were categorized according to their effectiveness and what Health Action Process Approach (HAPA) stage of change they would affect. Results: We identified 68 intervention trials using 26 unique BCTs and 13 MoAs to increase participation. Sixteen BCTs and 10 MoAs were identified within the interventions that successfully increased participation rates. Interventions targeting both stages of the HAPA model had a higher success rate (80%) than those targeting one stage of change (51%). When targeting only one stage, interventions targeting the volitional stage had a higher success rate (71%) than interventions targeting only the motivational stage of change (26%). Conclusion: Importantly, this review identified a suite of BCTs and MoAs effective for increasing participation in mail-out bowel cancer screening programs. With increased participation in bowel cancer screening leading to improved survival, our findings are key to informing the improvement of policy and interventions that aim to increase screening using specific strategies at key stages of health decision-making.

Keywords: HAPA; behavior change techniques (BCTs); bowel cancer screening; interventions; realist review/synthesis.

Publication types

Systematic Review