Community approaches to increasing colorectal screening uptake: a review of the methodological quality and strength of evidence

In Australia, colorectal cancer screening rates are sub-optimal and considerably lower than those of other countries. The purpose of the current review was to identify in relation to colorectal cancer screening: (i) the number of Australian and international community-based intervention studies published between 2002-2011, (ii) the proportion of intervention studies that had adopted a community-based approach and met the Cochrane Effective Practice and Organisation of Care study design criteria; and (iii) the effectiveness of community-based interventions with at least a moderate level of methodological rigour at increasing colorectal cancer screening rates. Electronic database searches identified 86 intervention studies, of which 21 used a community-based approach and 15 met Cochrane Effective Practice and Organisation of Care study design criteria. Overall, the methodological rigour of community-based intervention studies using Cochrane Effective Practice and Organisation of Care -accepted study designs was moderate. Only one methodologically robust Australian community-based study was identified. Based on findings from studies with moderate methodological rigour, a number of potential options which the National Bowel Cancer Screening Program might consider to increase screening rates are discussed. The current review highlights the urgent need for further methodologically rigourous, community-based colorectal cancer screening intervention research in the Australian setting.