Effectiveness and Acceptability of Targeted Text Message Reminders in Colorectal Cancer Screening: Randomized Controlled Trial (M-TICS Study)

Abstract

Background: Mobile phone-based SMS text message reminders have the potential to improve colorectal cancer screeningparticipation rates. Objective: This study assessed the effectiveness and acceptability of adding targeted SMS text message reminders to the standardprocedure for those who picked up but did not return their screening kit at the pharmacy within 14 days in a colorectal cancerscreening program in Catalonia, Spain. Methods: We performed a randomized control trial among individuals who picked up a fecal immunochemical test (FIT) kitfor colorectal cancer screening at the pharmacy but did not return it within 14 days. The intervention group (n=4563) receivedan SMS text message reminder on the 14th day of kit pick up and the control group (n=4806) received no reminder. A 30-dayreminder letter was sent to both groups if necessary. The main primary outcome was the FIT completion rate within 30, 60, and126 days from FIT kit pick up (intention-to-treat analysis). A telephone survey assessed the acceptability and appropriateness ofthe intervention. The cost-effectiveness of adding an SMS text message reminder to FIT completion was also performed. Results: The intervention group had higher FIT completion rates than the control group at 30 (64.2% vs 53.7%; P<.001), 60(78.6% vs 72.0%; P<.001), and 126 (82.6% vs 77.7%; P<.001) days. Participation rates were higher in the intervention armindependent of sex, age, socioeconomic level, and previous screening behavior. A total of 339 (89.2%) interviewees consideredit important and useful to receive SMS text message reminders for FIT completion and 355 (93.4%) preferred SMS text messagesto postal letters. We observed a reduction of US $2.4 per participant gained in the intervention arm for invitation costs comparedto the control arm. Conclusions: Adding an SMS text message reminder to the standard procedure significantly increased FIT kit return rates andwas a cost-effective strategy. SMS text messages also proved to be an acceptable and appropriate communication channel forcancer screening programs.