The intervention, known as Call for a Kit, or CFAK, was commissioned by NHS England North West in 2015 and targets general practices where screening uptake falls below 60 percent. Its design deliberately departs from the standard population-based approach. Instead of another impersonal letter, a non-clinical health promotion team trained in cultural competence telephones people who have not returned their FIT kit within 18 weeks of their invitation. Before the call, everyone receives a text message warning them to expect contact, with the option to opt out. Those who stay on the line are offered a 15-minute consultation, either face to face or by telephone, in which the barriers that stopped them from screening are discussed openly. Participants are shown the kit, watch a demonstration video, and can request a replacement kit directly from the screening programme on their behalf. The model mirrors the core principles of patient navigation, an approach pioneered in cancer care that has repeatedly shown benefits for minority and economically disadvantaged populations.

Between July 2022 and February 2023, researchers led by Sandro Tiziano Stoffel of the University of Basel and University College London, together with colleagues from Blackpool Teaching Hospitals, the University of Surrey, and the University of Lancashire, evaluated the programme across 27 GP practices in Lancashire. The team analysed detailed call logs for 2,360 screening non-responders, recording demographic information including gender, age, ethnicity, disability status, and area-level deprivation measured by the Index of Multiple Deprivation. The primary outcome was simple and clinically meaningful: whether a person went on to order and return a FIT kit after contact with the health promotion team. Because the study was a service evaluation of an existing NHS programme rather than a randomised trial, the researchers analysed the data both on an intention-to-treat basis, counting everyone the team tried to call, and on a per-protocol basis, counting only those who actually received a consultation.

The numbers reveal both the challenge and the promise of outreach work. Just over half of the 2,360 people called, 52.6 percent, answered the phone. Of those reached, 249 declined the invitation outright, but 696 opted for an in-person consultation and 297 chose a telephone consultation. Attendance at in-person clinics was strong, with 68.3 percent showing up, and roughly half of attendees, 50.3 percent, went on to order and return a test kit. Telephone consultations converted at a lower rate of 31.5 percent. Taken across the entire contacted sample, 333 people completed a test, an overall completion rate of 14.1 percent. That figure is broadly consistent with the programme’s earlier evaluation under the older guaiac fecal occult blood test, which achieved 15.3 percent, but the researchers note an important shift in who is now being reached: because FIT has lifted uptake above 60 percent at most practices, the remaining non-responders targeted by CFAK are more ethnically diverse and more economically deprived than before.

The most striking findings concern equity. In adjusted multivariate logistic regression models, people of Indian ethnic background were more than twice as likely as White adults to return a kit after the intervention, with 22.0 percent versus 13.6 percent doing so, an adjusted odds ratio of 2.26. People of Black, mixed, or other ethnic backgrounds returned kits at 27.9 percent, an adjusted odds ratio of 2.65. The effect was even larger for people with disabilities, who returned kits at 33.7 percent compared with 12.7 percent among those without a disability, an adjusted odds ratio of 3.58. Ordering patterns followed the same gradient: individuals with disabilities were over seven times more likely to request a replacement kit, and those of Indian or Pakistani background were also significantly more likely to order one. In other words, the intervention worked best precisely among the groups that routine invitations have historically failed to reach, a reversal of the usual pattern in which population-level programmes widen inequalities.

The evaluation also exposed where the intervention leaks. People living in the least deprived areas were less likely to answer the phone than those in the most deprived quintile, an adjusted odds ratio of 0.46, while individuals aged 70 to 74 were more likely to pick up than those aged 60 to 64. Yet older participants were paradoxically less willing to accept the CFAK invitation once reached, and first-time invitees in their early sixties proved hardest to engage overall. Individuals with disabilities answered their phones at a remarkable 96.3 percent rate and accepted the invitation at 90.5 percent, suggesting that for this group the personal phone call itself removes a critical access barrier. Ethnic minority participants, particularly those of Indian and Pakistani backgrounds, were more likely to accept the invitation and to prefer in-person consultations, which the per-protocol analysis showed were more effective at converting interest into completed tests than telephone consultations.

Why do so many people ignore their screening invitation in the first place? The call logs captured self-reported reasons from 960 respondents, and the answers are strikingly mundane. Indifference toward cancer screening was the most common explanation at 20.4 percent, followed by a missing or misplaced kit at 16.8 percent, and simply not knowing how to use the test at 15.8 percent. Overall, more than half of respondents cited practical barriers such as losing the kit, lacking information, or dealing with health problems and busy schedules. Among ethnic minority respondents, missing kits, indifference, and information gaps dominated, while people with disabilities most often pointed to health issues and lack of information. These are precisely the kinds of modifiable obstacles that a person-centred conversation, a demonstration video, and a replacement kit delivered on request can resolve, which helps explain why the intervention converts nearly one in seven of even the hardest-to-reach non-responders.

The authors are careful about the limits of their evidence. As an observational service evaluation, the study cannot prove causation, and it remains unknown whether some non-responders would eventually have completed screening without the call. Deprivation was estimated from GP practice postcodes rather than individual addresses, small cell sizes forced some ethnic groups to be pooled, and the content of individual consultations was not recorded. The researchers also caution that Lancashire’s population diversity, while close to the national average, may not generalise to regions with very different demographics. They argue that a randomised comparison of CFAK against no intervention or alternatives is now needed, alongside cost-effectiveness analysis, particularly given that systematic reviews suggest patient navigation embedded in routine care is cost-effective internationally. They also recommend testing pre-notification text messages and optimised call timing to reduce the roughly half of calls that go unanswered.

For now, the Lancashire findings offer a rare piece of good news in the fight against screening inequality. A modest, non-clinical intervention, built on cultural competence, choice of consultation format, and practical problem-solving, re-engaged a meaningful share of people whom the standard system had written off, and it did so most powerfully for ethnic minorities and people with disabilities, the very groups whose participation lags furthest behind. As England’s screening programme extends to younger ages and grapples with persistent deprivation gaps, the message from Lancashire is that sometimes the most advanced technology in cancer prevention is a trained, sympathetic voice on the telephone, and a replacement kit in the post.

Subject of Research: Community-delivered patient navigation for reducing inequalities in colorectal cancer screening participation

Article Title: Are community-delivered patient navigation interventions the answer for targeting colorectal cancer screening inequalities? Findings from Lancashire's “Call for a KIT” intervention

Article References: Stoffel, S. T., Hanif, S., Morris, L., Kerrison, R., Hirst, Y., & Von Wagner, C. (2026). Are community-delivered patient navigation interventions the answer for targeting colorectal cancer screening inequalities? Findings from Lancashire's “Call for a KIT” intervention. Frontiers in Cancer Control and Society, 4, Article 1518293. https://doi.org/10.3389/fcacs.2026.1518293

Image Credits: AI Generated

DOI: 10.3389/fcacs.2026.1518293

Keywords: colorectal cancer screening, patient navigation, health inequalities, fecal immunochemical test, bowel cancer screening programme, community health workers, ethnic minorities, disability, Lancashire, screening uptake, health promotion, NHS