Result card

  • ORG2: What kind of involvement has to be mobilized for participants and important others?

What kind of involvement has to be mobilized for participants and important others?

Authors: Principal investigators: Valentina Prevolnik Rupel, Nika Berlic Investigators: Dominika Novak Mlakar, Taja Čokl, Plamen Dimitrov, Marta López de Argumedo

Internal reviewers: Americo Cicchetti, Daniela D'Angela, Marco Marchetti

Acknowledgments: /

Analysis of selected studies extracted from the basic literature search. Two articles and one document with guidelines were relevant to this question.


A Netherlands study found that attitudes towards CRC screening strongly correlated with participation. People who considered screening to be ineffective, those expressing anxiety and those who are not familiar with CRC screening tests were less likely to participate. Knowledge of CRC and screening is therefore a positive predictor of participation. According to the study, having acquaintances affected by CRC increased screening participation. Researches also indicated that CRC screening participants are more often engaged in other health-promoting interventions, such as regular dental visits and other forms of cancer screening; those who are more familiar with health prevention are more likely to participate in screening. Italian study also indicates that physical health below average was a positive predictor of FOBT screening participation. A possible explanation may be that those of worse physical health may worry more about their health or are more familiar with health care and therefore are more inclined to participate. The fact that the absence of abdominal complaints is the main reason for non-participation in FOBT screening, and that insufficient knowledge significantly correlates with non-participation highlights the need of adequately informing the target population, including making individuals aware that CRC symptoms mostly occur late in the course of the disease and CRC can be present without symptoms. This Netherlands study reveals that only 12% of non-participants had made an informed choice on non-participation. So, screening organisations should focus on adequate information provision to the target population by for example suitable information brochures, information meetings, and media coverage, as this will affect the two of the most important parameters for the success of screening: informed choice and participation {13}.

Another study showed participants' low awareness of the faecal occult blood test before they received the invitation for screening. Awareness of bowel cancer was mainly through past experience or family history or was work-related. Data suggested that demography and cultural issues such as age, sex, taboo, attitudes, altruism, so-called ostrich syndrome, and stoicism can affect behaviour and decisions. Knowledge and awareness were identified as factors in breaking some of the cultural barriers affecting uptake {14}.

According to several studies one of the major factors that influence the participation in screening programme is increasing knowledge. Therefore it is highly important to make a screening programmes and information about screening easily accessible. Different strategies for making screening programme easily accessible are used. The most widely used strategy is to consider the size of the population and the patients’ geographic distribution and to establish local screening centres for better availability. Also mobile screening vans can be used for more distant areas.

Selection and management of the participants through the screening process needs to be well organized. Participants must receive complete information about benefits and risks, as well as pros and cons of participation in screening programme. Patient, who decides to participate in the screening process, needs to be aware and consider the screening protocol. According to the data of European guidelines the test kit may be delivered by mail, at GPs’ offices or outpatient clinics, by pharmacists, or in other community facilities, and in some cases with the support of volunteers, who can deliver the kits and collect samples {4}.

In order to reduce the probability of a false positive result, dietary restrictions are usually recommended when guaiac-based tests are used. More recent randomised trials have demonstrated that better compliance can be achieved using FIT compared to a gFOBT test, because FIT does not require modification of a subject’s diet and sampling is limited to one or two bowel movement. In order to enhance compliance European guidelines therefore recommend testing procedures that require no or only minor dietary restrictions {4}.

Distribution of task is also presented in the picture below (i.e. Figure 4):

pdf10936.ORG-2 Figure 4


Rupel P et al. Result Card ORG2 In: Rupel P et al. Organisational aspects In: Jefferson T, Cerbo M, Vicari N [eds.]. Fecal Immunochemical Test (FIT ) versus guaiac-based fecal occult blood test (FOBT) for colorectal cancer screening [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali; 2014. [cited 21 June 2021]. Available from: