Abstract

Executive Summary
This report presents the evaluation of the Blackburn with Darwen (BwD) Bowel Cancer Screening Project, a system-level intervention designed to increase uptake of bowel cancer screening among eligible residents aged 53–74. The initiative was developed in response to persistently low screening rates in the borough and aimed to leverage existing digital tools within primary care settings to engage non-responders.
The intervention included:
1. EMIS pop-up alerts to prompt opportunistic conversations during patient contact.
2. Targeted SMS messaging from GP practices, with options for patients to request kits.
3. A Protected Learning Time (PLT) event to share best practices and promote wider adoption.
Key Findings
The University of Lancashire conducted a mixed-methods evaluation, focusing on implementation experiences across 22 GP practices. Quantitative data shows that SMS messages had a minimal impact on improving participation with less than 1% of the non-responders subsequently completing a test kit (n=33/4995). The low test kit return rate is concerning, despite a considerable number of non-responders having requested a replacement kit (n=645). This warrants an exploration of individual-level data to understand the characteristics of individuals who are likely to respond to SMS messages. This could provide insights to ensure those who are less likely to respond to SMS messages could be approached using other methods (e.g., telephone or face to face consultations).
The qualitative interviews with 11 stakeholders—including GPs, practice managers, and implementation leads—provided rich insights into the acceptability, feasibility, and perceived impact of the intervention. Six themes were developed from the qualitative analysis:
1. Understanding and Awareness of the Intervention: Primary care staff demonstrated varying levels of awareness and understanding of the intervention’s aim and operational requirements, with communication gaps and the rapid launch impacting coherence.
2. Confidence and Capability for Implementation: Confidence in delivering the intervention was shaped by digital literacy, role-specific experience, and access to supportive systems, with collaborative team dynamics acting as key enablers.
3. Emotional and Ethical Engagement: Participants expressed strong professional commitment to improving screening uptake, though this was tempered by ethical concerns, emotional fatigue and the complexities of engaging diverse communities.
4. Practical and Resource Constraints: Time pressures, administrative burden, and competing priorities affected the feasibility and sustainability of the intervention, especially in practices with limited staffing or digital literacy.
5. Perceived Impact and Effectiveness: Text messaging and clinician-led conversations were seen as valuable, but barriers such as digital exclusion and lack of follow-up data limited reach.
6. Recommendations for Future Delivery: Participants suggested included clearer messaging, visual demonstrations, culturally tailored approaches, streamlined workflows and greater integration into routine workflows to enhance future delivery.
The findings were framed using the Theoretical Framework of Acceptability (TFA), which helped identify the factors most influencing staff engagement. Staff generally found the intervention acceptable, particularly where there was clear communication, supportive infrastructure, and integration into existing workflows. High levels of professional commitment and ethical alignment were evident, though practical constraints and opportunity costs sometimes limited engagement. The intervention’s perceived effectiveness was greatest when personalised and relationship-based approaches were used.
Recommendations
• Strengthen onboarding and internal communication.
• Provide templates and training to support implementation.
• Use culturally sensitive messaging that utilises trusted patient and health care professional relationships.
• Integrate screening prompts into routine appointments.
• Ensure timely feedback and outcome data to sustain engagement.
This report offers transferable learning for Integrated Care Boards, Cancer Alliances and commissioners of screening programmes seeking to improve cancer screening uptake through scalable, system-level approaches.
Conclusion
Overall, the intervention had a small but positive impact on screening uptake among previous non-responders. Stakeholder perspectives indicated that the intervention was broadly acceptable to primary care staff while its effectiveness has been less than optimal. Its sustainability and impact will depend on addressing resource constraints, enhancing onboarding and training, and ensuring culturally sensitive delivery that utilised trusted relationships between health care professionals (HCP) and patients. Embedding these elements into routine practice will be critical for maximising both acceptability and effectiveness in future initiatives.