%0 Journal Article
%@ 2291-5222
%I JMIR Publications
%V 13
%N 
%P e64243
%T Text Messaging Versus Postal Reminders to Improve Participation in a Colorectal Cancer Screening Program: Randomized Controlled Trial
%A Vives,Nuria
%A Binefa,Gemma
%A Travier,Noemie
%A Farre,Albert
%A Panera,Jon Aritz
%A Casas,Berta
%A Vidal,Carmen
%A Ibáñez-Sanz,Gemma
%A Garcia,Montse
%A ,
%+ Catalan Institut of Oncology, Gran Via de L'Hospitalet 199-203, Hospitalet del Llobregat, 08908, Spain, 34 93 260 72 05, mgarcia@iconcologia.net
%K text message
%K mobile health
%K colorectal cancer
%K screening
%K participation
%K reminders
%K text messaging
%K colorectal cancer screening
%K fecal immunochemical test
%D 2025
%7 1.1.2025
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
%X Background: Mobile phone SMS text message reminders have shown moderate effects in improving participation rates in ongoing colorectal cancer screening programs. Objective: This study aimed to assess the effectiveness of SMS text messages as a replacement for routine postal reminders in a fecal immunochemical test–based colorectal cancer screening program in Catalonia, Spain. Methods: We conducted a randomized controlled trial among individuals aged 50 to 69 years who were invited to screening but had not completed their fecal immunochemical test within 6 weeks. The intervention group (n=12,167) received an SMS text message reminder, while the control group (n=12,221) followed the standard procedure of receiving a reminder letter. The primary outcome was participation within 18 weeks of the invitation. The trial was stopped early, and a recovery strategy was implemented for nonparticipants in the intervention group. We performed a final analysis to evaluate the impact of the recovery strategy on the main outcome of the trial. Participation was assessed using a logistic regression model adjusting for potential confounders (sex, age, and deprivation score index) globally and by screening behavior. Results: The trial was discontinued early in September 2022 due to the results of the interim analysis. The interim analysis included 5570 individuals who had completed 18 weeks of follow-up (intention-to-treat). The SMS text message group had a participation rate of 17.2% (477/2781), whereas the control group had a participation rate of 21.9% (610/2789; odds ratio 0.71, 95% CI 0.62-0.82; P<.001). As a recovery strategy, 7591 (72.7%) out of 10,442 nonparticipants in the SMS text message group had an open screening episode and received a second reminder by letter, reaching a participation rate of 23% (1748/7591). The final analysis (N=24,388) showed a participation rate of 29.3% (3561/12,167) in the intervention group, which received 2 reminders, while the participation rate was 26.5% (3235/12,221) in the control group (odds ratio 1.16, 95% CI 1.09-1.23; P<.001). Conclusions: Replacing SMS text messages with reminder letters did not increase the participation rate but also led to a decline in participation among nonparticipants 6 weeks after the invitation. However, sending a second reminder by letter significantly increased participation rates among nonparticipants within 6 weeks in the SMS text message group compared with those who received 1 postal reminder (control group). Additional research is essential to determine the best timing and frequency of reminders to boost participation without being intrusive in their choice of participation. Trial Registration: ClinicalTrials.gov NCT04343950; https://www.clinicaltrials.gov/study/NCT04343950 
%R 10.2196/64243
%U https://mhealth.jmir.org/2025/1/e64243
%U https://doi.org/10.2196/64243