Better ask than tell: addressees’ response to mHealth interrogative reminders

Abstract

Background: Population screening for the early detection of colorectal cancer (CRC) was adopted, worldwide, mainly by older adults and women. Text-message interrogative reminders are effective in enhancing screening uptake. This analysis examined text-message response rate by message type (interrogative/declarative); analyzed responses content; associate responses with senders' characteristics and subsequent screening. Methods: Text message reminders (interrogative/declarative) to undergo screening were sent to 40,000 women and men, aged 50 to 74 years, at average-risk for CRC who were non-adherent in the previous two years. The invitations and reminders were part of a routine mailed-invitation wave to undergo annual Fecal Occult Blood Test (FOBT) under an Early Detection Program. Responses were analyzed for content; associated longitudinally with subsequent screening uptake. Results: Interrogative text-message reminders elicited 1475 responses while declarative ones elicited 146 responses. Most responses were positive towards screening and expressed an intention to screen. In a multivariable logistic regression among responders, FOBT at 6 months was significantly predicted by older age, past sporadic screening and intentions; gender was non-predictive. Text-message responders screened more than non-responders six months following the reminders (25.8% vs. 8.8%, χ2=420.7, P<0.0001); a year later (21.7% vs.12.4%, χ2=98.6, P<0.0001); two years later (14.2% vs.10.5%, χ2=19.2, P<0.0001). Conclusions: Interrogative text-message reminders reached uninvolved sectors in the CRC target population: men, 'sporadic-screenees' and the 'never-tested' before. Interrogative text-message reminders filtered the target population, thus contributing to a population-level, significant, incremental enhanced screening participation. The reported intervention is an added a tool to the ones at the disposal of screening program administrators.