Optimising SMS content for bowel cancer screening participation in Australia: cross-sectional national survey findings.

Clinical Snapshot

Key Findings

• P Value: Not applicable (Bayesian framework — posterior probabilities used rather than frequentist p-values)

• Effect Size: Kit-storage prompt: SD +0.44; GP-endorsement message: SD +0.32; Instruction-based message: SD +0.22 — all superior to reminder-only reference. Slight variation by age and area-level SES was observed.

• Primary Outcome: Perceived likelihood that each SMS type would encourage FIT kit return, compared with a reminder-only reference message, modelled via Bayesian multilevel cumulative probit regression

• Nnt Or Sensitivity: Not calculable from available data; no absolute risk differences or number-needed-to-screen equivalents reported. The SD-difference metric does not directly translate to kit return rate improvements without additional modelling assumptions.

• Confidence Interval: Posterior credible intervals not reported in the abstract

Clinical Application

SMS reminders are low-cost, scalable, and technically feasible within existing NBCSP infrastructure. Implementation of content modifications (adding kit-storage prompts, GP endorsement language, or step-by-step instructions) would require coordination between the Australian Government Department of Health and Aged Care and the NBCSP program administrator. No new technology or significant resource investment is required beyond message content revision. The NBCSP currently mails FIT kits to eligible Australians aged 45–74 years (expanded from 50–74 in 2024), with participation rates remaining suboptimal (approximately 40–44% kit return nationally). SMS reminders are already used in some jurisdictions. This study provides direct, locally-derived evidence to optimise SMS content for the Australian context. The findings are relevant to RACGP preventive care guidelines and the Australian Cancer Plan's target to increase bowel cancer screening participation. GP endorsement messaging aligns with the RACGP's role in promoting preventive screening. No PBS or TGA considerations apply as this is a behavioural/communication intervention. CALD and Aboriginal and Torres Strait Islander populations, who have lower NBCSP participation, are not specifically addressed and would require separate culturally adapted research. Australians aged 50–74 years eligible for the National Bowel Cancer Screening Program (NBCSP), particularly those who have received but not yet returned their FIT kit

Abstract

OBJECTIVES AND IMPORTANCE OF STUDY: This study aimed to identify short message service (SMS) reminder content perceived as most likely to prompt bowel cancer screening, examine differences across sociodemographic subgroups, and explore preferences for timing and frequency. METHODS: Australian residents (N = 1016) aged 50-74 years completed an online survey rating five SMS reminders presented in random order. Outcomes included perceived usefulness, likelihood of encouraging kit return, likelihood of irritation and clarity. Preferences for timing and frequency were also assessed. Bayesian multilevel modelling (cumulative probit) compared ratings across SMS types, with effect sizes expressed as standard deviation (s.d.) differences in perceived likelihood that each SMS would encourage kit return compared with a reminder-only message. Interactions with age, gender, socioeconomic status and screening history were explored. RESULTS: Compared with a 'reminder-only' message, SMS content that encouraged storing the kit near the toilet (s.d. 0.44), conveyed general practitioner endorsement (s.d. 0.32) and gave instructions (s.d. 0.22) was more likely to prompt kit return. Responses varied slightly by age and area-level socioeconomic status. Most participants preferred two to three SMS reminders (mean 2.89, s.d. 6.73). CONCLUSIONS: SMS reminders using behavioural prompts and clear, concise content may support improved screening participation. Tailored SMS messages that reflect public preferences may increase kit return rates, support national screening goals and reduce bowel cancer mortality.

References

1. 1.Perry, N., Ireland, M. J., Daken, K., Wilson, C., Jenkins, M., Ait Ouakrim, D., McIntosh, J. G., Baxter, N. N., Pearse, E., & Goodwin, B. C. (2026). Optimising SMS content for bowel cancer screening participation in Australia: cross-sectional national survey findings. Public Health Research & Practice. https://doi.org/10.1071/PU25121