Simple follow-up, measurable effect
Automated text-message reminders could help narrow London’s persistent gap in bowel cancer screening, according to a randomized controlled trial led by the University of Surrey. The study tested ways to reach people who had not acted on an initial invitation to complete a screening test, focusing on more than 3,000 people across eight London boroughs.
The result is notable less for technological novelty than for its practicality. The researchers found that both automated texts and personalised telephone support tripled screening uptake among initial nonresponders compared with receiving no follow-up. Text messages were also judged cost-effective, at £1.82 for each additional person screened.
London’s bowel cancer screening uptake is 63.8%, according to the study report—eight percentage points below the national average. Screening matters because detecting bowel cancer earlier can improve outcomes, yet a substantial number of people who receive test kits do not complete them.
How the reminder programme worked
The automated approach was deliberately straightforward. Initial nonresponders received text reminders at 19, 21, 23 and 25 weeks after their original invitation. In the trial, uptake in that group rose from 2.0% without follow-up to 6.5% with the text-message schedule.
That is an increase of 4.5 percentage points among people who had already missed the first opportunity to take part. Put another way, the intervention did not need to persuade the entire eligible population at once; it concentrated on the point in the screening process where participation had stalled.
The study’s estimate suggests a London-wide rollout of the text approach could bring an additional 18,000 people into bowel cancer screening each year. The researchers project that this increase would lead, on average, to 50 additional bowel cancers being detected at an earlier stage, when they are usually more treatable.
Telephone support produced a higher overall rate
The second intervention paired people with trained navigators who could offer personalised telephone support and help address specific barriers to screening. Overall uptake reached 7.5% in that group. The researchers said the phone intervention was particularly effective when they were able to speak with men, including people whose main obstacle was simply forgetting to complete the kit.
That contrast is important for implementation. Automated messages can be delivered widely and cheaply, while a conversation can address circumstances a reminder cannot: uncertainty about the process, practical questions, or a lapse in attention. The reported results point to follow-up as a continuum rather than a choice between a digital system and human contact.
A targeted response to an uneven public-health problem
The trial was conducted in London, where screening participation trails the national figure. Its design also focused on a defined population: people who had not responded to an initial invitation. That makes the findings useful for services considering where a modest intervention may have the greatest effect.
The evidence does not imply that a text alone resolves every reason someone may delay screening. The telephone findings underline that some people benefit from tailored support. But the study shows that the absence of a response to an initial invitation need not be treated as a final decision.
For health services, the practical attraction is clear. The text programme uses automated messages at specified intervals, while its estimated cost per additional person screened is low. The potential gains described by the researchers arise from applying that relatively small prompt at scale to a group already known to be at risk of being missed.
What the study adds
Bowel cancer screening programmes often depend on people completing a test kit after it arrives. The trial adds controlled evidence that a follow-up system can materially change participation among those who did not do so initially. It also provides a direct comparison between two forms of outreach: repeated automated texts and navigator-led telephone support.
Neither finding removes the need for wider work to understand why screening uptake varies across London. However, the results give programme leaders a tested option that can be deployed without waiting for a more complex redesign. The text route raised uptake to 6.5%, and the personalised call route raised it to 7.5%, against 2.0% in the no-follow-up comparison.
The research, published in the British Journal of Cancer, frames a familiar technology as a public-health tool: a timely reminder can convert an uncompleted invitation into participation. For a city below the national screening average, even a small percentage-point change among nonresponders can translate into thousands more people screened and more cancers identified earlier.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
