JMIR Publications

ABSTRACT

Background:

Appropriate annual screenings for colorectal cancer (CRC) are an essential preventative measure for the second-leading cause of cancer death in the US. Studies have shown that colorectal cancer (CRC) screening rates are influenced by various social determinants of health (SDOH) factors, including race and ethnicity and geography. According to 2018 national data, participation in screening is lowest among Lantinx individuals (56.1%). At an urban Federally Qualified Health Center (FQHC), many patients were found to be out-of-date with screening guidelines. A quality improvement project to pilot a texting campaign with a motivational fotonovela – a short narrative comic – was conducted. Fotonovelas have previously been used by programs to improve knowledge about cervical cancer and HPV, vaccinations, and treatments for depression.

Objective:

This project aimed to engage patients and encourage screening compliance of a home-mailed screening kit campaign through the use of a texting program with fotonovelas and messaging informed by behavioral change techniques. It sought to understand qualitative characteristics about patient compliance and barriers to completing their screening.

Methods:

5,241 aged 50 to 75 and either English or Spanish speaking were randomized to either intervention (4-week tailored two-way texting campaign with a fotonovela comic) or control. The texting vendor used a proprietary algorithm to determine the SDOH index bands for intervention patients’ home addresses, for analysis. Over four weeks, patients were prompted answer questions related to whether they had returned their FIT, what barriers they may be experiencing, and what their thoughts of the fotonovela were.

Results:

SDOH index analysis showed that the majority of the population in this study were in the High (21.4%) and Very High (54.5%) Impact bands. The average SDOH index was higher amongst patients whose preferred language was Spanish (84) compared to English (71), out of a maximum value of 100. Patients sent 1,969 total responses to the texting system. Thematic analysis found three major themes in these responses: (1) patients were motivated to return the FIT kit and had already done so or would do so as soon as possible; (2) the intervention increased patients’ knowledge about the purpose and importance of the FIT test; and (3) patients were willing to share barriers to or reasons for not completing the FIT test.

Conclusions:

It appears that patients across all SDOH bands are receptive to receiving texting programs and fotonovelas. Additionally, creating culturally tailored messaging can enhance the quality of the engagement and generate insights about gaps and barriers to behavior change. It is important to continue to develop and assess strategies that aim to engage patients who did not respond to the program, in order to better support all patients with CRC screening across the continuum of care.