Last reviewed: 15 October 2025
Last reviewed: 15 October 2025
When looking for ways to support informed bowel screening uptake, it's important to understand who is not engaging with the programme and the barriers that prevent them. Evidence shows some of the common barriers include:
Fear and denial around the test outcome
A misconception that the test is for people with symptoms of bowel cancer
Concerns around the practicalities and cleanliness of the test
Low individual risk perception or limited consideration of future consequences of bowel cancer
Forgetting to complete the test
Difficulty accessing information on the test or bowel cancer due to low health literacy or language barriers
Some groups of people face more significant or frequent barriers to participating in screening. In the UK, although there are gaps in data availability, there’s evidence that the following groups are less likely to participate in bowel cancer screening:
People from areas of higher deprivation or with lower socioeconomic status
Men
Younger eligible people
First-time invitees
People from non-white ethnic minority communities
People of certain religions (eg Hindu, Muslim, Sikh)
People with disabilities
[21, 26, 27, 28]People with severe mental illness
People who smoke
Previous non-responders
Taking part in bowel cancer screening is an individual choice, but one that should be equally available to everyone.
We’ve developed a practical tool that can be used alongside local uptake data and insights to help you identify which interventions are most likely to improve bowel screening uptake among groups with lower participation across the UK. The tool brings together evidence on the effectiveness of different interventions and can support you to:
Prioritise and target interventions based on their potential to improve uptake in specific groups or across multiple underserved populations.
Understand barriers and enablers to participation for different groups, using behaviour change models to map interventions accordingly.
Plan implementation and evaluation by considering practical steps to embed and assess your chosen intervention(s).
We recommend watching the introductory video for a walk-through of the tool and how it can be used in practice.
Download this toolWe welcome feedback on this tool and insights into how you’re using it in your role via our survey.
Below are some of the primary-care level interventions that have been shown to improve participation in bowel cancer screening. Other interventions may be implemented at a national level e.g., implementing FIT return deadlines – see the above tool for a more holistic list of interventions.
A study found that offering non-responders a phone or face-to-face consultation with a health promoter can boost screening uptake by up to 15.3%
. These sessions explain how to do the test, address common concerns and barriers, and offer replacement kits.GP endorsement via a letter has been shown to increase uptake by up to 6%, and up to 12% when combined with enhanced patient information
.The Practice Endorsed Additional Reminder Letter (PEARL) project also found GP-endorsed reminder letters to improve uptake. Patients who hadn’t returned a test kit after the standard 28-day reminder were sent a second reminder - this time on GP letterhead and signed by the GP, which increased uptake by 3%
.Text reminders may increase uptake amongst first-time invitees
, though overall impact is mixed. Ongoing projects, like the iPLATO and Small Business Research Institute (SBRI) initiative, are exploring how texts can reduce inequalities and improve uptake.Text reminders have also been shown to be effective at improving uptake in other cancer screening programmes
.Download our bowel cancer screening primary care good practice guide(PDF, 1.1 MB) for templates and scripts for GP-endorsed calls, texts and letters.
People with a positive FIT result will be offered follow-up investigation, usually a colonoscopy or sometimes a computer tomography colonography (CTC) or a colon capsule endoscopy (CCE). Recent figures show that around 1 in 4 people with a positive FIT result in Scotland (2022–24)
and England (2023–24) did not attend their follow-up colonoscopy. Barriers to attendance may include anxiety about the procedure and the potential of a cancer diagnosis and surgery. Much like bowel cancer screening, there’s evidence that these barriers are more common or persistent for some groups of people, including people from non-white ethnic minorities and from areas of higher deprivation.Usually, people with a positive FIT are offered an appointment with a specialist nurse or a specialist screening practitioner (SSP). Here, the patient's fitness for a follow-up test is assessed, and they're provided information and counselling to help them make informed decisions about attending further tests. You can play an important role in supporting people to attend their SSP appointment and further tests.
Explain why follow-up is needed: Blood was found in their poo, and further tests will help find out why.
Reassure people: The SSP appointment will help assess their suitability for follow-up investigations, usually a colonoscopy, and they'll be provided with information and support to help them make an informed decision about further tests. Inform them that a colonoscopy can help detect cancer early, when treatment is more likely to be effective, or even prevent it by removing polyps. You can signpost people to our information on colonoscopies.
Flag adjustments: Let patients know they can request reasonable adjustments to help make them feel more comfortable, like longer appointments or a preferred gender of the colonoscopist (check what adjustments are available locally).
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