{
  "abstract": "Introduction: Men over 60 are the least likely to participate in the Colorectal Cancer Screening Programme of the Valencia Community (CRCSP-VC). This study assesses three invitation-based behavioural nudges of increasing intensity to boost screening participation among never-screened men over 60 (hard-to-reach population).\n\nMethods: A randomized controlled trial within the CRCSP-VC (Spain, Feb–Sep 2025) targeting never-screened men over 60 from the screening-eligible population, randomly assigned to one control and three intervention groups. The control group (n = 1,600) received the usual invitation (letter plus pre-paid card to accept the invitation; if accepted, the screening test was mailed home); Intervention groups (I) received escalating nudges: I1 (n = 1,600), usual invitation plus a modified letter using behavioural change messages; I2 (n = 1,600), I1 plus choice of pre-paid card or SMS to accept; I3 (n = 1,200), I1 plus direct home delivery of the screening test. Descriptive and multivariate (logit CI95%) analysis of the outcome variable (participation in CRCSP-VC), by region, age and socio-economic status (SES) (Q1=best to Q4=worst). Randomised Control Trial Registry: https://doi.org/10.1186/ISRCTN52248153. Ethics Committee approval (20241220/03/E).\n\nResults: Participation rates were 5.4% (control group), 6.5% (I1), 7.7% (I2), and 19.7% (I3). Compared to controls, adjusted ORs were: I1 (OR1.20; CI 0.73-1.97); I2 (OR1.53; CI 0.94-2.50); and I3 (OR 4.30; CI 2.67-6.95). Participation increases in I3 vs control group in all SES levels (p < 0.05): (Q1: 4.2% vs 19.1%; Q2: 6.3% vs 22.0%; Q3: 1.7%-16.1%; Q4: 8.9% vs 20.8%).\n\nConclusions: Nudge intensity strongly predicts screening uptake. Directly mailing the screening test to participantśhome produced a four-fold participation increase, with consistent gains across all socioeconomic groups, suggesting this strategy can meaningfully reduce screening inequalities in hard-to-reach populations.\n\nKey messages: • Participation rates increase significantly when the screening test is included directly with the invitation letter.\n\n• Sending the screening test directly with the invitation letter reduces screening inequalities in hard-to-reach populations.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "abstract",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "name": "A Molina-Barceló"
    },
    {
      "name": "E Pérez-Sanz"
    },
    {
      "name": "P Romeo-Cervera"
    },
    {
      "name": "I Iturbe-Ormaeche"
    },
    {
      "name": "D Jiménez-Gómez"
    },
    {
      "name": "S Castán-Cameo"
    },
    {
      "name": "M Besó"
    },
    {
      "name": "M Vanaclocha-Espí"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2qcbn5b8gdvdk.bib",
  "cited_by": 0,
  "doi": "10.1093/eurpub/ckag169.547",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13697755/",
  "id": "2qcbn5b8gdvdk",
  "issns": [
    "1101-1262",
    "1464-360X"
  ],
  "landing_url": "https://doi.org/10.1093/eurpub/ckag169.547",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "3. PARALLEL PROGRAMME"
    ],
    [
      "heading",
      "AcademicSubjects/MED00860"
    ],
    [
      "heading",
      "AcademicSubjects/SOC01210"
    ],
    [
      "heading",
      "AcademicSubjects/SOC02610"
    ],
    [
      "openalex",
      "2730|Colorectal Cancer Screening and Detection"
    ]
  ],
  "openalex": "W7223709170",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13697755/pdf/?tool=EBI",
  "pmcid": "PMC13697755",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/2qcbn5b8gdvdk.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:45Z",
      "native_id": "PMC13697755",
      "source": "pmc",
      "url": "https://doi.org/10.1093/eurpub/ckag169.547"
    },
    {
      "first_seen": "2026-10-30T12:21:47Z",
      "native_id": "PMC:PMC13697755",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13697755"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Colorectal Cancer Screening and Detection",
      "subfield": "oncology"
    }
  ],
  "title": "Nudging Hard-to-Reach Populations Toward Spanish Colorectal Cancer Screening (JA PreventNCD study)",
  "title_text": "Nudging Hard-to-Reach Populations Toward Spanish Colorectal Cancer Screening (JA PreventNCD study)",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:34:44Z",
  "url": "https://research.draconitic.com/paper/2qcbn5b8gdvdk",
  "venue": "The European Journal of Public Health",
  "versions": []
}