Neoplasms

Digestive System Diseases

All Conditions

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Participants do not receive a reminder letter, which is treatment as usual.

Participants receive a reminder letter which is based on the current colorectal cancer screening invitation.

Participants receive a reminder letter which incorporates several behavioral components, including an active choice prompt, social norm, simplification, chunking and call to action.

Participants receive the behaviorally informed letter plus the colorectal home testing kit, which removes the current barrier of having to request a kit.

A reminder letter to encourage recipients to order the colorectal cancer home testing kit, based on the current invite letter.

Standard letter

A reminder letter to encourage recipients to order the colorectal cancer home testing kit, with incorporates severally behaviorally informed components, including an active choice prompt, social norm, call to action, chunking and simplification.

Behaviorally informed letter

The home testing kit is included with the reminder letter, instead of the usual process of responding to the letter to order the kit

Home testing colorectal cancer kit

Veerle Snijders

Tiina Likki

Ivana Brkić Biloš, MD

Nataša Antoljak, Prof

Colorectal cancer (CRC) is one of the leading causes of death in Croatia. An average of 3600 cases are diagnosed and an average of 2100 people die from the disease every year. Since 2007, Croatia has invited every man and woman aged 50-74 to participate in the home testing screening programme every two years. Currently only around 36% of the invited request the test-kit and 25% complete the home testing procedure, far below the target of 40-60%.

The Croatian Institute of Public Health with technical support from World Health Organization (WHO) Regional Office for Europe is undertaking a mixed-methods research study with the aim to increase the completion of colorectal cancer home testing and improve our knowledge of the barriers and drivers to do so. The study has a quantitative and a qualitative component:

1. Quantitative: testing the introduction of a reminder letter to encourage people to respond to the initial invite to participate in the CRC home test program and test which elements of a reminder letter improve response rates.

   The quantitative component consists of a four-arm reminder letter randomized controlled trial (RCT) comparing no letter, standard letter, behaviorally informed letter, and behaviorally informed letter sent with a home testing kit to investigate the effectiveness of reminders in increasing uptake of home-testing for colorectal cancer. Recruitment and data collection for the reminder letter trial will be conducted utilizing the routine screening process and routinely collected screening data.
2. Qualitative: conducting in-depth interviews with people from the target population who did or did not respond to the CRC invite letter and reminder to better understand the barriers and drivers to participation.

The qualitative component consists of 24 in-depth interviews (IDIs) conducted with members of the target population to identify barriers and drivers to completing colorectal cancer screening home-testing. Data collection for IDIs will be face-to-face, using discussion guides, and will be audio recorded. The audio-recordings will then be analyzed using a rapid analysis approach based on by the modified Capability-Opportunity-Motivation-Behavior (COM-B) framework.

Participants will be randomized to either control (no reminder screening invitation) or one of three treatments (standard reminder letter, behaviorally informed reminder letter, behaviorally informed letter with home testing kit included).

Using Behavioural and Cultural Insights to Increase Colorectal Cancer Home-testing in Croatia

Using Behavioural and Cultural Insights to Understand and Address Barriers and Drivers to Colorectal Cancer Home-testing in Croatia

The study utilizes the data that is routinely collected as part the Croatian National Screening Database, only specific approved members of the screening program are able to access and utilize this data. For this reason, it is currently not planned to share individual participant data.

Did the participant order the colorectal cancer home testing kit? Routinely collected data.

Did the participant complete the home testing kit and return it to the health authority? Routinely collected data.

Did the participant actively opt out of participating in the screening program? Routinely collected data.

Qualitative feedback on the intervention arms and colorectal cancer screening experience. Collected through 24 semi-structured interviews.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Using Behavioural and Cultural Insights to Increase Colorectal Cancer Home-testing in Croatia	NCT06341322	Colorectal Canc... Behavior Change	Standard letter Behaviorally in... Home testing co...	50 Years - 74 Years	World Health Organization
Using Behavioural and Cultural Insights to Increase Colorectal Cancer Home-testing in Croatia	NCT06341322	Colorectal Canc... Behavior Change	Standard letter Behaviorally in... Home testing co...	50 Years - 74 Years	World Health Organization

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