Table 3 A list of implementation strategies

The implementation strategies that were co-designed with practice nurses and other practice staff included:

• nurse training that encompassed how to use the CRISP tool, how to explain the risk output, and how to inform the doctors of the result;

• educational material designed for nurses, helping them explain CRISP results to the patients;

• provision of a sample National Bowel Cancer Screening FIT kit for the nurses to demonstrate how to do a test with patients;

• improved and more accurate instructions for patients on how to do a FIT test;

• a fidelity checklist for research staff to verify that CRISP was being used correctly, and to help the nurses self-audit (Fig. 1);

• training sessions for the doctors to ensure they understood the clinical implications of the CRISP output for their patients;

• the incorporation of CRISP into preventive health consultations including chronic disease management plan consultations;

• alerts in the patient management system, prompting the nurses to perform a CRISP assessment for eligible patients;

• engagement with local pathology providers to explore barriers to FOBT kit availability outside the NBCSP;

• engagement with local colonoscopic services to determine the availability of their services; and

• identifying a ‘champion’ in the practice to drive the implementation.