Leveraging Text Messaging and Behavior Theory to Improve Colorectal Cancer Screening in Federally Qualified Health Centers: Cohort Study

Summary

This cohort study tested how the timing and frequency of text-message reminders affect colorectal cancer screening among nearly 5,000 patients overdue for screening at two large federally qualified health center networks in Texas and California. Patients received no messages, a single reminder, a three-week sequence, or a six-week behavior-theory-informed sequence, delivered through CareMessage. Moderate-frequency reminders — especially the three-week schedule — significantly increased screening completion, while the most intensive schedule offered no added benefit. The findings help safety-net clinics design smarter, not just more frequent, outreach for low-income populations.

Key Findings

• The three-week reminder schedule significantly increased screening completion (adjusted odds ratio 1.27; p=0.02).
• A single reminder also significantly increased completion (adjusted odds ratio 1.22; p=0.04).
• The six-week, higher-frequency schedule showed no added benefit over usual care.
• The study included 4,822 patients; 58% were Hispanic and 45% were uninsured.

Clinical Significance

For cancer-screening outreach, timing and tailoring matter more than volume: moderate-frequency text reminders can meaningfully raise screening rates in safety-net clinics, while over-messaging adds cost without added benefit.

CareMessage Product Features

Programs

Citation

Angelocci T, Xu T, Talaparthy T, Corral C, Adepoju OE. Leveraging Text Messaging and Behavior Theory to Improve Colorectal Cancer Screening in Federally Qualified Health Centers: Cohort Study. J Med Internet Res. 2026;28:e86408. doi:10.2196/86408