In women, use of the leaflet did not affect compliance in those aged either 61 to 65 years (38% v 36% X2=-0 1, NS) or 66 to 70 years (31% v 31%, X2=O.O, NS). The positive rate of stool testing in patients observing the required dietary restrictions was 1.6%. A significant lesion was detected in 1.4% ofpeople tested (2 carcinomas and 5 patients with adenomatous polyps). Conclusions -Health education leaflets addressing reasons for non-compliance significantly increased compliance in men and should be used in screening programmes. Reasons for the lack of success of the leaflet in women should be investigated and other interventions for raising compliance should be developed.

Study objective -To ascertain reasons for non-compliance with faecal occult blood tests in colorectal cancer screening programmes. Design -A standard interview by a trained nurse of a random sample of those who declined screening. Setting -The Leicestershire town of Market Harborough, where most of the 25 000 population are served by a single general practice of 10 partners. Participants -Altogether 4185 residents aged 51 to 70 years were invited to receive a free faecal occult blood test (Haemoccult). Eighty one subjects from a sample of 351 who wrote declining the offer were interviewed. Main results -Non-compliers were divided into those who did not request a test kit and those who returned an unused kit. In the former group the commonest reasons given were intercurrent illness (39%), fear of further tests and surgery (24%), and feeling well (22%). For those who returned unused kits the commonest reasons were the unpleasantness of the stool collection procedure (65%), feeling well (30%), intercurrent illness (23%), and fear of further tests and surgery (20%). In both groups the main concern of those who did not comply were fear of further diagnostic tests and surgery rather than concern at the lack of effective treatment for cancer. Conclusions -To increase compliance, education and publicity must explain the concept of asymptomatic illness and allay people's fear of hospital investigation and treatment. The benefits of screening should be particularly emphasised to those who return kits so they may overcome their reservations.(J7 Epidemiol Community Health 1995;49:84-86) Colorectal cancer is the second commonest cause of death from malignancy in Britain, and results in over 20 000 fatalities each year. Those who were unwilling to be seen at home were asked if they would answer a structured questionnaire by telephone. Residents were told that the purpose of the study was to understand reasons for non-compliance so that more effective screening programmes could be designed. An assurance was given that answers were strictly confidential.A structured questionnaire (see appendix 1) which contained 11 reasons for rejection was used as the basis for the interview. The questionnaire was compiled by a discussion group comprising two hospital doctors, a general practitioner, a research nurse, and two nonmedical lay people. No standard questionnaire exists for inteviewing those who decline faecal

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