TOPLINE

A theory-based WhatsApp chatbot outreach intervention increased colorectal cancer (CRC) screening uptake by approximately 30% (8.4 percentage points) at 3 months compared to standard text reminders among asymptomatic adults aged 50–75 years in Hong Kong. The intervention delivered personalized risk assessments tailored to participants' readiness to screen and provided practical information on accessing screening services, with the benefit sustained at 6 months.

METHODOLOGY

• A prospective, open-label, two-arm, parallel randomized controlled trial was conducted in a community setting in Hong Kong from July to October 2024.
• A total of 500 asymptomatic adults aged 50–75 years eligible for government-subsidized fecal immunochemical test (FIT)-based CRC screening were randomized 1:1 to receive either WhatsApp chatbot outreach (WCO) or standard text reminder (STR).
• The WCO intervention assessed participants' stage of change based on the Transtheoretical Model (TTM) — precontemplation, contemplation, or preparation — and delivered a 4-minute health education video emphasizing perceived susceptibility, perceived benefits, and cues to action for those not ready to screen, followed by personalized CRC risk assessment using the Asia-Pacific Colorectal Screening score; participants in the preparation stage received district-specific contact information for participating primary care doctors.
• The STR group received a single text reminder indicating they were due for screening with a website link to the government organized CRC screening program.
• Primary outcome was FIT screening uptake at 3 months; secondary outcomes included uptake at 1 and 6 months, baseline screening intention, change in intention after intervention, time to screening completion, and reasons for screening or not screening.

TAKEAWAY

• At 3 months, FIT screening uptake was significantly higher in the WCO group compared to the STR group (36.00% vs 27.60%, P = .043).
• At 6 months, the difference remained significant, with uptake rates of 45.60% in the WCO group vs 36.40% in the STR group (P = .045).
• No significant difference in screening uptake was observed between groups at 1 month (22.40% vs 19.60%, P = .509).
• Among participants who completed screening, the median time from intervention to screening completion was similar between groups (62 vs 69 days, P = .418).

IN PRACTICE

"A theory-based virtual outreach using mobile health technology can substantially improve CRC screening uptake at 3 months, with supportive evidence that this improvement persisted at 6 months. By combining behavioral theory with a scalable, low-cost digital platform that integrates into the existing organized screening program, the intervention offers a useful strategy for accelerating screening uptake in settings with limited manpower," wrote the authors of the study.

SOURCE

The study was led by Thomas Yuen Tung Lam, The Nethersole School of Nursing, The Chinese University of Hong Kong in Hong Kong, and Joseph Jao Yiu Sung, Lee Kong Chian School of Medicine, Nanyang Technological University in Singapore. It was published online on August 13 in Clinical Gastroenterology and Hepatology.

LIMITATIONS

The study assessed initial FIT screening uptake but not longitudinal adherence to repeat screening. Screening completion was self-reported and could not be independently verified, introducing potential reporting bias. The requirement for written informed consent through WhatsApp may have selected more motivated or digitally engaged participants, limiting generalizability to the broader screening-eligible population.

DISCLOSURES

This study was supported by the Health and Medical Research Fund, Health Bureau of the Government of the Hong Kong Special Administrative Region. The authors reported 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.