Introduction : Participation in bowel cancer screening is lower in regions where there is high ethnic

diversity and / or socioeconomic deprivation. Interventions, such as text message reminders and

patient navigation (PN), have the potential to increase participation in these areas. As such, there is

interest in the comparative effectiveness of these interventions to increase bowel cancer screening

participation, as well as their relative cost-effectiveness.

Methods and Analysis: This study will use a three-arm randomised controlled trial design to

compare the effectiveness and cost-effectiveness of text message reminders and PN to increase the

uptake of bowel cancer screening in London. Participants will be individuals who have not returned a

completed faecal immunochemical test (FIT) kit within 13 weeks of receiving a routine invitation from

the London bowel cancer screening hub. Participants will be randomised (in a 1:1:1 ratio) to receive

either: (1) usual care (i.e. 'no intervention’), (2) a text message reminder at 13 weeks, followed by

repeated text message reminders at 15, 17 and 19 weeks (in the event of non-response); or, (3) a text

message reminder at 13 weeks, followed by PN telephone calls at 15, 17 and 19 weeks in the event

of non-response. The primary endpoint will be participation in bowel cancer screening, defined as ‘the

return of a completed kit by week 24’. Statistical analysis will use multivariate logistic regression, and

will incorporate pairwise comparisons of all three groups, adjusted for multiple testing.

Ethics and Dissemination: Approvals to conduct the research have been obtained from University

College London’s Joint Research Office (Ref: 150666), the Screening Research, Innovation and

Development Advisory Committee (‘RIDAC’, Ref: 2223 014 BCSP Kerrison), the Health Research

Authority (Ref: 22/WM/0212) and the Confidentiality Advisory Group (Ref: 22/CAG/0140). Results will

be conveyed to stakeholders, notably those managing the screening programme, and published in

peer-reviewed journals / presented at academic conferences.

Trial registration: This trial is registered with the International Standardised Randomised Controlled

Trials Number Registry (ISRCTN).