Does recruitment via GP letter or community advertisement to cancer screening influence uptake across socioeconomic groups? Exploring recruitment methods in the Early detection of Cancer of the Lung Scotland (ECLS) trial

Background/purpose: People are frequently invited to participate in cancer screening directly by their health care provider. However, this approach results in inequalities, with uptake of cancer screening being lower in those from more deprived groups. The evidence on the impact of community advertisement on cancer screening uptake across socioeconomic groups is limited. The ECLS trial invited 12,243 people at high risk of developing lung cancer to a lung cancer screening trial. Participants were recruited in two distinct ways, via: i) a letter from their GP; or ii) community advertisement. The primary aim of this study was to explore if recruitment method influenced uptake by socioeconomic status. The secondary aim was to explore any psychosocial differences among those recruited by the two recruitment methods.

Methods: A secondary analysis of ECLS trial data was conducted. The data included socioeconomic status (Scottish Index of Multiple Deprivation) and psychosocial measures (e.g. illness perceptions) from the study questionnaire (n=11,164). Univariate and multivariate analyses were conducted.

Results: People recruited via community advertisement lived in significantly less deprived areas than those recruited via GP letter (OR 0.67 [0.55-0.81]). Those recruited by community advertisement were more likely to agree that their actions could control their risk of lung cancer (92.2%) compared to those recruited via their GP (89.0%).

Conclusions and implications: Community advertisement for cancer screening recruited more people from less deprived areas than GP letters and was therefore not effective in reducing inequalities in screening uptake