JAMA network open · 2026
Behaviorally Informed Text Messaging to Promote Colon Cancer Screening: A Quality Improvement Randomized Clinical Trial.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Korostoff-Larsson Olivia, King William C, Pelegri Elan, Colella Doreen, Dapkins Isaac, Eng Kelly, Klapheke Nathan, Krelle Holly, Mahieu Nicholas, McManus Erika, Shahin George, Woodriff Molly, Horwitz Leora I, Elmaleh-Sachs Arielle
Аннотация
IMPORTANCE: Colorectal cancer screening rates in the US remain suboptimal, particularly among low-income and minoritized populations, despite the availability of effective, low-cost options such as the fecal immunochemical test (FIT). Scalable outreach strategies are needed to improve uptake and reduce staff burden in safety-net settings.
OBJECTIVE: To evaluate whether a behavioral economics-informed, automated text messaging strategy was associated with increased FIT completion compared with nurse-led telephone call outreach.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement randomized clinical trial was conducted from April 7 to June 24, 2025, at 8 Federally Qualified Health Centers (FQHCs) in Brooklyn, New York, within the Family Health Centers at NYU Langone. Participants included adults (aged ≥18 years) with a new FIT order who listed English, Spanish, or Chinese (Mandarin or Cantonese) as their preferred language and had not opted out of text messaging.
INTERVENTION: Patients were randomized 1:1 to receive either 3 automated, 1-way text message reminders on days 2, 5, and 8 (intervention) or a single nurse-led telephone call reminder on day 8 (usual care).
MAIN OUTCOMES AND MEASURES: The primary outcome was FIT completion within 21 days of the test order, assessed from the electronic health record. Secondary outcomes included completion at 7 and 14 days. FIT completion at 7, 14, and 21 days was compared between groups using χ2 tests.
RESULTS: Among 1275 eligible randomized participants, 649 were assigned to the text group (418 female participants [64.4%]; mean [SD] age, 56.4 [9.3] years) and 626 to the telephone group (398 female participants [63.6%]; mean [SD] age, 56.7 [9.6] years). FIT completion within 21 days was higher in the text group (382 of 649 participants [58.9%]) compared with the telephone group (312 of 626 participants [49.8%]) with an absolute difference of 9.0 percentage points (95% CI, 3.6-14.5 percentage points; P = .001). Post hoc analyses found no evidence of differential effectiveness by age, sex, race and ethnicity, or patient portal use.
CONCLUSIONS AND RELEVANCE: In this quality improvement randomized clinical trial, a behaviorally informed text messaging strategy was associated with significantly improved FIT completion compared with usual nurse-led telephone outreach. Automated messaging may offer a scalable, low-cost strategy to promote preventive care and reduce staff burden in underserved populations.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06632054.
OBJECTIVE: To evaluate whether a behavioral economics-informed, automated text messaging strategy was associated with increased FIT completion compared with nurse-led telephone call outreach.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement randomized clinical trial was conducted from April 7 to June 24, 2025, at 8 Federally Qualified Health Centers (FQHCs) in Brooklyn, New York, within the Family Health Centers at NYU Langone. Participants included adults (aged ≥18 years) with a new FIT order who listed English, Spanish, or Chinese (Mandarin or Cantonese) as their preferred language and had not opted out of text messaging.
INTERVENTION: Patients were randomized 1:1 to receive either 3 automated, 1-way text message reminders on days 2, 5, and 8 (intervention) or a single nurse-led telephone call reminder on day 8 (usual care).
MAIN OUTCOMES AND MEASURES: The primary outcome was FIT completion within 21 days of the test order, assessed from the electronic health record. Secondary outcomes included completion at 7 and 14 days. FIT completion at 7, 14, and 21 days was compared between groups using χ2 tests.
RESULTS: Among 1275 eligible randomized participants, 649 were assigned to the text group (418 female participants [64.4%]; mean [SD] age, 56.4 [9.3] years) and 626 to the telephone group (398 female participants [63.6%]; mean [SD] age, 56.7 [9.6] years). FIT completion within 21 days was higher in the text group (382 of 649 participants [58.9%]) compared with the telephone group (312 of 626 participants [49.8%]) with an absolute difference of 9.0 percentage points (95% CI, 3.6-14.5 percentage points; P = .001). Post hoc analyses found no evidence of differential effectiveness by age, sex, race and ethnicity, or patient portal use.
CONCLUSIONS AND RELEVANCE: In this quality improvement randomized clinical trial, a behaviorally informed text messaging strategy was associated with significantly improved FIT completion compared with usual nurse-led telephone outreach. Automated messaging may offer a scalable, low-cost strategy to promote preventive care and reduce staff burden in underserved populations.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06632054.