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Colorectal cancer population screening programs commonly suffer from poor participation. Therefore it is important to reduce as many barriers as possible. Some screening tests affect participation, this is associated with level of technology. As screening most effective when conducted regularly, it is important to determine the impact of the initial screening experience on participation in further rounds. This study determined the impact of the level of technology of the test used in the first round of offers on participation in a second round where all people were offered the test that elicited the highest participation in the first round (ie the 'preferred' test. In the first round there were 3 groups each offered sceening using a different test. Intervention group 1 used Hemoccult II Sensa, a low technology guaiac based test requiring restricted diet for 6 days, sampling stool by spatula and 6 applications of stool to collection device, Intervention group 2 used FlexSure OBT, a mid level technology immunochemical test without restricted diet, sampling stool by spatula, 3 applications of stool to collection device, Intervention group 3 used InSure OBT, high level technology- immunochemical test, without diet, sampling stool by brush, 2 applications of stool sample. Intervention group 3 (InSure) returned the highest participation and was thus considered the preferred test. All people received Insure in the second round of offers.

Improved participation in screening for bowel cancer is desirable. Large scale screening programs must recruit invitees through comprehensive population registers. Depending on the country and health system these may be primary care practice lists or other registers such as the electoral roll. If primary care patient lists are available, considerable practice time may be required to organise the screening program, alternatively the implicit practice endorsement of screening may increase the participation rate to make that investment worthwhile. As screening is most effective when conducted regularly, it is important to determine if any increase in participation rate due to practice or practitioner endorsement is maintained over several rounds of screening offers. This study aims to follow screening participation over 4 rounds of offers in 4 treatment groups, and to use innovative statistical methods to determine the value of practice involvement in re-sceening participation.