TOPLINE:

Automated text message reminders crafted using behavioral science principles, such inclusion of a deadline to motivate action, were associated with higher fecal immunochemical test (FIT) completion rates for colorectal cancer screening than a reminder phone call from a nurse.

METHODOLOGY:

• FIT is a commonly used stool-based screening test for adults at an average risk for colorectal cancer, but many patients fail to complete the test for a variety of reasons, including forgetting about it, being confused by the instructions, or feeling uncomfortable handling stool.
• Researchers conducted a quality improvement randomized clinical trial from April to June 2025 to assess the effect of text message reminders on FIT completion at eight federally qualified health centers in Brooklyn, New York City, with a follow-up period lasting up to July 2025.
• A total of 1275 adults with new FIT orders who had not opted out of text messaging were randomly assigned to receive an automated text message reminder on days 2, 5, and 8 after the FIT order (n = 649; mean age, 56.4 years) or a telephone call reminder from a nurse on day 8 (n = 626; mean age, 56.7 years). Text reminders were stopped early if FIT completion was logged.
• The one-way text messages were sent in the patient’s preferred language and included the clinic address and a centralized telephone number for questions or replacement kits. They also included behavioral science elements such as specific deadlines for a motivating effect, a reference to how the patient’s clinician is waiting for the test to foster accountability, and “gain-framed” language emphasizing that screening could save the patient’s life for positive encouragement.
• The primary outcome was completion of FIT — defined as the return and laboratory processing of the test kit — within 21 days of the test order, as assessed from the electronic health record. FIT completion at 7 and 14 days was also assessed.

TAKEAWAY:

• Among 457 participants in the call group eligible for reminders, nurses successfully reached 45.7%, left voicemails for 14.7%, and made unsuccessful contact attempts for 4.4%. No call data were available for 35.2%. In the text reminder group, 94.5% of text messages were successfully delivered.
• At 21 days, the FIT completion rate was significantly higher in the text message group (58.9%) than in the telephone call group (49.8%), with an absolute difference of 9 percentage points (P = .001).
• Assignment to the text group was associated with increased odds of FIT completion at 21 days (odds ratio, 1.58; P < .001), corresponding to an average marginal effect of 10.4 percentage points.
• By day 14, 54.2% of participants in the text group completed screening compared with 40.3% in the call group (absolute difference, 14 percentage points; P < .001).

IN PRACTICE:

“Although telephone calls are commonly used for preventive care reminders, our findings suggest that automated, but thoughtfully designed, messaging can outperform live outreach in a clinical safety-net setting,” the authors wrote. The results “demonstrate that even a simple, automated reminder can still meaningfully boost screening uptake when more intensive efforts are not feasible,” they added.

“The authors should be commended for leveraging existing evidence on how to design nudge messaging, applying it to historically underserved populations, and comparing it to traditional telephone-based models that are pervasive in healthcare but may no longer be fit for purpose,” experts wrote in an invited commentary. “Communication must reach patients through channels they notice, trust, and routinely use. Aligning communication strategy with patient behavior may be as consequential for improving outcomes as the clinical guidance conveyed in those communications.”

SOURCE:

This study, led by Olivia Korostoff-Larsson, BA, NYU Grossman School of Medicine in New York City, was published online in JAMA Network Open.

LIMITATIONS:

The intervention was carried out in one clinic network in a specific area, which may have limited how well the results applied to other contexts. While behavioral strategies can mitigate cognitive barriers to screening, they do not tackle issues such as unstable housing, lack of transportation, or other priorities that may prevent people from participating in screenings.

DISCLOSURES:

NYU Langone Health provided support for this work, with no external grant funding utilized. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.