Every year, 2.12 million bowel cancer screening kits are posted out across the UK and never returned, costing the NHS £11.1 million in unused tests alone. This matters because bowel cancer is the fourth most common cancer in the UK, with 44,000 new cases and 16,800 deaths each year. Only 48% of cases are caught at the earliest, most treatable stages—far short of the NHS target of 75% by 2028. Uptake of the faecal immunochemical test (FIT) is especially low in socioeconomically disadvantaged and minority communities, driving stark health inequalities in diagnosis and survival. This project will work directly with those underserved groups to understand why they do not return the kits. Researchers will build community partnerships, train local research link workers, and run co-production workshops to design a tailored intervention that addresses real-world barriers. The goal is not a one-size-fits-all campaign but a practical, community-rooted strategy to boost FIT returns. If successful, this work could increase early detection rates, reduce bowel cancer deaths, and save the NHS millions in wasted kit costs—while providing a roadmap for inclusive engagement that can be applied to other screening programmes.
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Development work questions What are the key barriers and facilitators to faecal immunochemical test (FIT) use among diverse communities, and how can these insights inform the development of tailored, equitable interventions? How can we effectively engage underserved groups to co-produce community-based interventions that improve FIT uptake and return rates? Background: Colorectal cancer (CRC) is the fourth most common cancer in the UK, with 44,000 new diagnoses and 16,800 deaths annually. Early diagnosis significantly improves survival rates, yet only 48% are detected at the earliest stages (Stages 1 or 2). This is far short of the NHS target of 75% by 2028. Health inequity is recognised to be prevalent across the entire CRC pathway. This is contributing to low early detection rates and poorer CRC outcomes in underserved communities. FIT is now embedded in CRC screening and symptomatic pathways. The uptake of FIT however remains suboptimal, particularly in socioeconomically disadvantaged and minority communities. Approximately 2.12 million FIT samples are distributed annually and are never returned. This is costing the NHS £11.1 million in FIT kits alone. To improve early CRC detection, reduce mortality, meet NHS targets and minimise healthcare costs, community-engaged research is now needed to improve FIT uptake. Aims and Objectives: This project aims to develop and evaluate methods for effectively engaging underserved groups in co-producing a community-based intervention to improve FIT uptake and return. The objectives are to: Build sustained partnerships with diverse and underserved communities to address inequities in FIT access and uptake. Understand barriers to FIT use among underserved groups. Co-produce a tailored intervention package and implementation plan integrating evidence, behaviour change theory, and lived experiences. Establish a roadmap for inclusive, ethical engagement of underserved populations in research to enhance FIT reach, uptake, and impact. Development work plan: The project consists of three work packages: WP1: Building and developing community partnerships Establish a diverse steering committee Recruit and train Community Research Link Workers Conduct community meetings and engagement activities WP2: Participatory systems mapping and qualitative research Conduct participatory systems mapping workshops Develop Theory of Change and Logic Model Identify barriers and facilitators to FIT uptake WP3: Co-production of the intervention Conduct mixed-methods systematic review on FIT uptake and implementation in underserved groups Develop prototype intervention strategies Conduct co-production workshops with key stakeholders Refine intervention package and implementation plan Timelines for delivery: Months 1-6: Establish partnerships, conduct participatory systems mapping Months 7-12: Complete evidence synthesis. Months 13-18: Conduct co-production workshops Months 19-24: Finalise intervention package and implementation plan Months 25+: Dissemination, PGfAR development Anticipated impact and dissemination: This project will: 1) build lasting partnerships between researchers and underserved communities; 2) co-develop an intervention aimed at improving FIT uptake; and 3) provide evidence on the feasibility and acceptability of the co-designed approach. These findings will directly inform a future Programme Grant for Applied Research (PGfAR), focusing on refining strategies for the implementation and scale-up of the intervention, which will enhance FIT uptake and address CRC inequity.
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