• Sarah W Huf, David A Asch, Kevin G Volpp, Catherine Reitz, and Shivan J Mehta.
• Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA. s.huf@imperial.ac.uk.
• J Gen Intern Med. 2021 Jul 1; 36 (7): 1958-1964.

BackgroundRoutine screening reduces colorectal cancer mortality, but screening rates fall below national targets and are particularly low in underserved populations.ObjectiveTo compare the effectiveness of a single text message outreach to serial text messaging and mailed fecal home test kits on colorectal cancer screening rates.DesignA two-armed randomized clinical trial.ParticipantsAn urban community health center in Philadelphia. Adults aged 50-74 who were due for colorectal cancer screening had at least one visit to the practice in the previously year, and had a cell phone number recorded.InterventionsParticipants were randomized (1:1 ratio). Individuals in the control arm were sent a simple text message reminder as per usual practice. Those in the intervention arm were sent a pre-alert text message offering the options to opt-out of receiving a mailed fecal immunochemical test (FIT) kit, followed by up to three behaviorally informed text message reminders.Main MeasuresThe primary outcome was participation in colorectal cancer screening at 12 weeks. The secondary outcome was the FIT kit return rate at 12 weeks.Key ResultsFour hundred forty participants were included. The mean age was 57.4 years (SD ± 6.1). 63.4% were women, 87.7% were Black, 19.1% were uninsured, and 49.6% were Medicaid beneficiaries. At 12 weeks, there was an absolute 17.3 percentage point increase in colorectal cancer screening in the intervention arm (19.6%), compared to the control arm (2.3%, p < 0.001). There was an absolute 17.7 percentage point increase in FIT kit return in the intervention arm (19.1%) compared to the control arm (1.4%, p < 0.001).ConclusionsSerial text messaging with opt-out mailed FIT kit outreach can substantially improve colorectal cancer screening rates in an underserved population.Trial Registrationclinicaltrials.gov ( https://clinicaltrials.gov/ct2/show/NCT03479645 ).© 2020. Society of General Internal Medicine.

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