SMS Messaging as a Tool to Improve Cancer Screening Programs (M-TICS)

Implementation of Text Messaging (SMS) as an Improvement Tool in Population-based Cancer Screening Programs

The aim of this project is to assess the impact on health and economics of the implementation of text messaging (SMS) in cancer screening programs. Three interventions with SMS will be evaluated through community trials. In the colorectal cancer screening program the following interventions will be tested: a) Participation reminder: six weeks after sending the invitation letter of the colorectal cancer program if there has not been a response, a reminder SMS will be sent in front of the usual method by letter; b) Reminder to return the fecal occult blood test: SMS reminder of test delivery versus no intervention. This reminder will be sent to the individuals who have gone to the pharmacy to pick up a fecal occult blood test and they have not returned it after 14 days. The impact on participation will be analyzed and, if applicable, the proportion of advanced neoplasms will be calculated by increase in participation. In the breast cancer screening program, the invitation by SMS versus the usual invitation by letter will be studied in women who had participated in the previous screening round. The impact on participation will be analyzed. A cost-effectiveness analysis of the three interventions will be carried out. The incremental cost ratio of the interventions between cost variation and effectiveness variation will be calculated.

Main Hypothesis: The implementation of SMS in population-based cancer screening programs will improve participation, especially in colorectal cancer screening, will allow a better resource management and reduce costs in both programs. Specific Hypothesis: Sending the reminder SMS will have an impact on participation greater than that obtained with the standard reminder (letter) in the colorectal cancer screening program. The effect of the colorectal cancer screening reminder SMS will be greater among the individuals who have been invited for the first time and not previous participants. Participation after receiving the invitation by SMS in breast cancer screening will be equal to or better than the letter invitation. The alternative that includes sending SMS will be cost-effective in relation to the current alternative that you use postal shipping.

Uptake, Participation, Cost-effectiveness, Breast cancer screening, Colorectal cancer screening, Text-message, Mobile-health

Intervention 1: SMS reminders for colorectal cancer screening compared to reminder letters. Intervention 2: SMS reminders to return the fecal occult blood test at the pharmacy compared to no intervention. Intervention 3: Invitation by SMS for women with a prior participation in the breast cancer screening program compared to invitation letter.

Invited individuals to the cancer screening programs will not be aware of the different arms of the study.

SMS reminders will be sent to individuals who received an invitation letter from Colorectal Cancer Screening Program and haven't participated within 6 weeks.

Reminder letters will be sent to individuals who received an invitation letter from the Colorectal Cancer Screening Program and haven't participated within 6 weeks.

SMS reminders will be sent to individuals who picked the fecal immunochemical test at the pharmacy and haven't returned it within 14 days.

Invitation by SMS will be sent to women who previously participated in the Breast Cancer Screening Program.

Cluster randomization instead of individual randomization will be used. The cluster will be "invitation week". Individuals assigned to the experimental arm with a wrong phone number will get a reminder letter (protocol analysis).

Cluster randomization instead of individual randomization will be used. The cluster will be "invitation week". Individuals with a wrong phone number assigned to the experimental arm will not get any reminder (protocol analysis).

Individual randomization. Women assigned to the experimental arm and with a wrong phone number will get an invitation letter (protocol analysis).

Participation (no/yes) will be gathered prospectively 18 weeks after sending the screening invitation letter (week 0).

Intervention 2: Participation in colorectal cancer screening program among individuals who pick the test at the pharmacy

Participation (no/yes) among those individuals who pick the screening test for colorectal cancer at the pharmacy 18 weeks after sending the screening invitation letter (week 0).

Participation (no/yes) will be gathered prospectively 8 weeks after sending the screening invitation letter (week 0).

A cost-effectiveness analysis of the three interventions will be carried out. The incremental cost ratio of the interventions between cost variation and effectiveness variation will be calculated.

Inclusion Criteria: Eligible individuals for colorectal cancer screening (intervention 1 and 2) Eligible women for breast cancer screening (intervention 3) Registered at the HealthCare Database (RCA) Exclusion Criteria: Individuals without a mobile phone number registered at the RCA Opt out from breast cancer screening and/or colorectal cancer screening

Vives N, Farre A, Ibanez-Sanz G, Vidal C, Binefa G, Mila N, Perez-Lacasta MJ, Travier N, Benito L, Espinas JA, Bagaria G, Garcia M. Text messaging as a tool to improve cancer screening programs (M-TICS Study): A randomized controlled trial protocol. PLoS One. 2021 Jan 22;16(1):e0245806. doi: 10.1371/journal.pone.0245806. eCollection 2021.