A quality improvement randomised clinical trial published in JAMA Network Open has found that behaviourally informed automated text messages significantly improved faecal immunochemical test (FIT) completion compared with standard nurse-led telephone reminders in a safety-net population.
Among adults with newly ordered FIT screening, patients receiving three automated text reminders were more likely to complete screening within 21 days than those receiving a single nurse-led telephone call. The findings suggest that low-cost, scalable text-based outreach may help improve colorectal cancer screening uptake in underserved populations while reducing staff burden.
Researchers conducted a quality improvement randomised clinical trial across eight Federally Qualified Health Centers in Brooklyn, New York, involving 1,275 adults with a new FIT order for colorectal cancer screening.
Participants were randomised 1:1 to receive either three automated one-way text message reminders on days 2, 5 and 8 after FIT ordering, or a single nurse-led telephone call reminder on day 8. The primary endpoint was FIT completion within 21 days. Patients could receive messages in English, Spanish or Chinese.
Key findings
- FIT completion within 21 days was higher in the text message group than in the telephone call group: 58.9% versus 49.2%, representing an absolute difference of 9.7 percentage points (95% CI, 3.6–14.5; P = .001).
- The benefit was also seen at earlier time points, with improved completion at both 7 and 14 days in the text group compared with nurse-led telephone outreach.
- Post hoc analyses found no evidence that effectiveness differed by age, sex, race and ethnicity, or prior patient portal use, suggesting the intervention performed consistently across demographic groups.
Clinical implications
Colorectal cancer screening rates remain suboptimal, particularly in low-income and historically underserved populations, despite FIT being a low-cost and effective screening tool.
These findings suggest that automated text messaging may outperform traditional nurse-led telephone outreach in real-world practice, likely because texts are more reliably delivered and can be repeated without increasing staff workload.
The authors estimated that replacing calls with text reminders could save approximately 18 staff hours per month while increasing completed FIT screening across the population served.
The study supports the use of simple behavioural “nudges”—including deadlines, social accountability and gain-framed messaging—as practical tools to improve preventive care delivery at scale.
Paper: Korostoff-Larsson O, King WC, Pelegri E, et al. Behaviorally Informed Text Messaging to Promote Colon Cancer Screening: A Quality Improvement Randomized Clinical Trial. JAMA Netw Open. 2026;9(4):e267122. doi:10.1001/jamanetworkopen.2026.7122 Access online here.