JMIR Publications

ABSTRACT

Background:

Delays in completing cancer screening diminish the preventive benefits of early detection, particularly among women receiving care in Federally Qualified Health Centers (FQHCs).

Objective:

This study examined factors associated with time to cancer screening completion among women aged 50 years or older who participated in an SMS text message outreach campaign, in a large 56-clinic FQHC network.

Methods:

Female patients aged 50 years or older who received at least three reminder SMS messages encouraging completion of any of the following overdue cancer screening tests: (a) mammogram, (b) FIT/Cologuard, or (c) HPV/Pap test. The outcome variable was the time (in days) to the completion of the cancer screening test following the initial SMS reminder. The primary independent variable was the type of cancer screening test: mammogram (breast cancer screening), FIT or Cologuard (colorectal cancer screening), or HPV/Pap testing (cervical cancer screening). Other independent variables included sociodemographic characteristics, health status and access to care variables, and health-related social needs variables, including food insecurity, social isolation, housing insecurity, and transportation challenges. A Cox proportional hazards model was applied to quantify the associations between time to screening completion and the independent variables and covariates. All analyses were performed using R version 4.4.2 in RStudio. Hazard ratios (HRs) and their 95% confidence intervals were obtained by exponentiating the model coefficients.

Results:

The median survival times (in days) for the overall cohort, HPV/Pap, Mammogram, FIT/Cologuard groups were 59.0 (95% CI: 53–65), 72.5 (95% CI: 64–86), 52.0 (95% CI: 43–64), and 52.0 (95% CI: 52–53), respectively. Compared with patients who were overdue for HPV/Pap screening, patients in the FIT group (HR = 1.65, 95% CI: 1.34–2.05, p < 0.001) and the mammogram group (HR = 1.41, 95%CI: 1.11–1.78, p < 0.001) had a significantly higher likelihood of completing screening sooner, reflecting shorter times to screening completion. Screening positive for transportation as a social need was associated with delayed screening completion (HR = 0.74, 95% CI: 0.55–0.99, p = 0.045).

Conclusions:

These findings indicate that transportation barriers are associated with longer time to cancer screening completion among women aged 50 years or older. In addition, the slower completion of HPV/Pap screening compared with FIT and mammogram suggests that cervical cancer screening may require more intensive follow-up, tailored outreach messages, or enhanced counseling to reduce delays in completion time.