Leveraging Text Messaging and Behavior Theory to Improve Colorectal Cancer Screening in Federally Qualified Health Centers: Cohort Study

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but CI excludes 1.0

• Effect Size: 3-week SMS group: aOR 1.27 (combined model), aOR 7.01 (Cologuard-only)

• Primary Outcome: CRC screening completion within 90 days

• Nnt Or Sensitivity: Approximately 15-20 patients need SMS intervention for one additional screening

• Confidence Interval: 95% CI 1.05-1.53 (combined), 95% CI 1.96-25.07 (Cologuard)

Clinical Application

Highly feasible - low-cost intervention using existing SMS infrastructure Directly applicable to Australian community health centres and Aboriginal Community Controlled Health Organisations. Aligns with National Bowel Cancer Screening Program goals and could complement existing reminder systems Adults ≥45 years in community health settings, particularly vulnerable populations

Abstract

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Despite recommendations for screening to begin at the age of 45 years, significant disparities persist, particularly among medically underserved populations. OBJECTIVE: This study examines the effectiveness of SMS text messaging reminders in improving CRC screening rates across 2 large federally qualified health centers (FQHCs) serving vulnerable populations. METHODS: The study included 4822 adults aged ≥45 years, receiving care at 2 large FQHC networks in Texas and California. Participants were assigned to one of four groups: (1) control (no SMS text messages), (2) single-outreach SMS text overdue message, (3) three-week SMS overdue and reminder text messages, and (4) six-week SMS text messages that were informed by behavior theory. Data were collected from May 2023 to July 2024. The outcome measure was a binary indicator of whether the participant underwent 1 of 3 CRC tests, fecal immunochemical test, colonoscopy, and Cologuard, within 90 days of completing the SMS text messaging reminders. Independent variables included demographic, geographic, clinical, and primary care access variables. Multivariate logistic regression models were used to examine associations between CRC screening completion and the SMS text messaging reminder groups, adjusting for covariates. Adjusted odds ratios (aORs) and 95% CIs were reported. RESULTS: In the combined 3-test model, patients in the single-outreach SMS text message (aOR 1.22, 95% CI 1.00-1.47) and the 3-week SMS text message (aOR 1.27, 95% CI 1.05-1.53) groups had higher odds of completing the screening test compared to those in the control group. Within the fecal immunochemical test-only model, patients in the 3-week SMS text message group (aOR 1.25, 95% CI 1.00-1.56) were more likely to complete the screening test. Within the Cologuard-only model, patients in the 3-week SMS text message group (aOR 7.01, 95% CI 1.96-25.07) and the 6-week SMS text message group (aOR 5.75, 95% CI 1.53-21.61) had significantly higher odds of CRC screening completion. CONCLUSIONS: The findings highlight that moderate-frequency SMS text messaging reminders can effectively increase CRC screening rates in FQHCs; however, critical factors include the timing and frequency of these reminders. The 3-week intervention was associated with improved screening uptake, whereas the 6-week theory-informed intervention did not demonstrate a significant advantage over the control group, potentially reflecting a ceiling effect or message fatigue associated with more frequent messaging. Additionally, the study highlights unique screening patterns that contradict previous literature, underscoring the importance of a tailored approach for vulnerable communities.

References

1. 1.Angelocci, T., Xu, T., Talaparthy, T., Corral, C., & Adepoju, O. E. (2026). Leveraging text messaging and behavior theory to improve colorectal cancer screening in federally qualified health centers: Cohort study. Journal of Medical Internet Research, 28(5), e86408. https://doi.org/10.2196/86408