Behaviorally Informed Text Messaging to Promote Colon Cancer Screening: A Quality Improvement Randomized Clinical Trial
Mené aux Etats-Unis auprès de 1 275 participants (âge moyen : environ 56,5 ans ; environ 64,5 % de femmes), cet essai randomisé évalue la performance, du point de vue de la réalisation d'un test FIT dans les 21 jours qui suivent la prescription, d'une intervention comportant trois rappels automatiques par SMS unidirectionnels les jours 2, 5 et 8 par rapport à un seul rappel effectué par téléphone par une infirmière le jour 8
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
JAMA Network Open , article en libre accès, 2026