Increasing bowel cancer screening using SMS in general practice: the SMARTscreen cluster randomised trial

Area of Science:

• Public Health
• Gastroenterology
• Health Services Research

Background:

• Australia faces high colorectal cancer (CRC) incidence, necessitating effective screening strategies.
• The National Bowel Cancer Screening Program (NBCSP) has low uptake (40.9%), limiting its impact.
• General practitioner (GP) endorsement is a key factor in improving screening participation.

Purpose of the Study:

• To evaluate a multi-component Short Message Service (SMS) intervention designed to increase NBCSP uptake.
• To compare the effectiveness of SMS intervention against usual care in a randomized controlled trial.
• To assess the impact on screening participation in 50-60-year-old individuals eligible for the NBCSP.

Main Methods:

• A stratified cluster randomized controlled trial involving 21 general practices in Western Victoria, Australia.
• Intervention group received a personalized SMS with GP endorsement, motivational and instructional videos, and information links prior to NBCSP kit delivery.
• Control group received usual care; primary outcome was the difference in Faecal Immunochemical Test (FIT) screening uptake within 12 months.

Main Results:

• The SMS intervention group achieved a 39.2% FIT screening uptake, compared to 23.0% in the usual care group.
• This represents a significant increase in screening uptake of 16.5% (95% CI: 2.02 to 30.9).
• The intervention demonstrated a positive impact on NBCSP kit return among the target demographic.

Conclusions:

• A multi-intervention SMS strategy, incorporating GP endorsement and multimedia content, effectively increases NBCSP participation.
• This intervention shows promise for broader implementation to improve CRC screening rates in Australia.
• Findings support further investigation in a larger, national trial (SMARTERscreen) to confirm efficacy in a diverse population.