High-Touch vs Low-Touch Strategy for Implementing a CRC Screening Digital Health Intervention: A Randomized Clinical...

Area of Science:

• Health Services Research
• Digital Health Implementation
• Cancer Prevention

Background:

• Low colorectal cancer (CRC) screening rates are a significant public health concern.
• Patient, clinician, and system-level barriers impede CRC screening uptake.
• Mobile health (mHealth) apps are explored as a strategy to address these barriers.

Purpose of the Study:

• To evaluate if a more intensive implementation strategy increases the use of a mobile app designed to overcome multilevel barriers to CRC screening.
• To assess the impact of the mHealth app on CRC screening completion rates.

Main Methods:

• A hybrid type 3 effectiveness-implementation pragmatic trial involving 18 primary care practices.
• Practices were randomized to either a low-touch or a high-touch implementation strategy for a CRC screening tablet app.
• Primary outcomes included app reach (percentage of eligible patients completing the app) and effectiveness (CRC test completion within 16 weeks post-implementation).

Main Results:

• Overall patient use of the CRC app was low, decreasing from approximately 5.5% in the first month to 1% by the sixth month, irrespective of implementation intensity.
• High-touch implementation showed a trend towards increased use of the CheckIn app (OR, 2.8) and CRC app (OR, 1.7) compared to low-touch, though not statistically significant for CheckIn.
• No significant difference in CRC screening completion rates was observed after app implementation compared to the pre-implementation cohort (OR, 0.9).

Conclusions:

• Patient-facing mHealth apps for CRC screening demonstrated low utilization and did not improve screening completion rates, regardless of implementation intensity.
• Persistent challenges such as staff turnover, post-pandemic fatigue, workflow complexities, and time constraints may limit the effectiveness of implementation strategies.
• Further research is needed to identify more effective strategies for integrating digital health tools into routine cancer screening workflows.