JMIR Publications

ABSTRACT

Background:

Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. Despite recommendations for screening to begin at age 40, significant disparities persist, particularly among medically underserved populations. This study examines the effectiveness of SMS text reminders in improving CRC screening rates across two Federally Qualified Health Centers (FQHCs) serving vulnerable populations.

Objective:

This study examines the effectiveness of SMS text reminders, informed by the theory of behavior change (TOBC), in improving CRC screening rates across FQHCs serving vulnerable populations.

Methods:

The study consisted of four implementations: i) control group (no SMS messages), ii) single outreach SMS overdue message, iii) three-week SMS overdue and reminder messages, and iv) six-week SMS messages that are behavior theory-informed. Data were collected from May 2023 to December 2023 in the U.S. The study enrolled 4,822 adults aged 45 and older from Texas and California. The outcome measure was a binary indicator showing whether the participant underwent one of three CRC tests: Fecal Immunochemical Test (FIT), colonoscopy, or Cologuard, within 90 days of completing the intervention. The independent variables included demographic, geographic, clinical, and primary care access variables. Statistical analyses were conducted to determine the association between CRC screening completion and the intervention groups, adjusting for covariates.

Results:

Test completion rates were 24% in the control group and 27%, 28%, and 27% in cohorts 2–4, respectively. Weekly reminders over a three-week period significantly improved screening rates (OR = 1.27, p = 0.02). Single messages and intensive six-week interventions showed no significant improvement, suggesting diminishing returns sets in after three SMS reminders. While the majority of the sample completed FIT tests, Colonoscopy/Cologuard tests had higher completion rates than FIT tests (OR=12.44, p<0.001). Screening completion was higher among Spanish speakers (OR=1.47, p<0.001) compared to those who speak English only, but declined with advancing age (OR=1.47, p<0.001). Compared to those enrolled in Medicaid, uninsured patients, the majority of whom received FIT tests, had higher screening rates (OR=1.74, p<0.001).

Conclusions:

The findings highlight that moderate-frequency SMS reminders can effectively increase CRC screening rates in FQHCs; however, critical factors include the timing and frequency of these reminders. Additionally, the study highlights unique screening patterns that contradict previous literature, underscoring the importance of a tailored approach for vulnerable communities.