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From SMS Text Messaging to Screening Completion: Understanding How SMS Responses Influence Cancer Screening Uptake in
Omolola E Adepoju1,2, Tonghui Xu2, Tracy Angelocci3
1Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, Texas, USA.
Health Services Research
|May 28, 2026
Summary
Patient engagement with SMS text reminders significantly mediated cancer screening completion. Interactive messaging may improve cancer screening uptake, especially in underserved populations.
Area of Science:
- Public Health
- Health Communication
- Health Services Research
Background:
- Federally Qualified Health Center clinics (FQHCs) serve vulnerable populations, often facing barriers to cancer screening.
- SMS text reminders are a potential tool to improve patient engagement and cancer screening completion.
Purpose of the Study:
- To examine the mediating role of patient engagement with SMS text reminders in cancer screening completion.
- To compare the effectiveness of a 3-week interactive SMS intervention versus a 6-week theory-informed SMS intervention.
Main Methods:
- A randomized controlled trial involving 4,344 patients overdue for cancer screening at FQHCs.
- Mediation analysis was used to assess the association between SMS response rates and cancer screening completion within 90 days.
- Sociodemographic characteristics, insurance type, and health status were considered as exposure variables.
Main Results:
- SMS engagement partially mediated cancer screening completion.
- Full mediation was observed for insurance type, with private insurance showing higher completion rates.
- Partial mediation was noted for Medicare, uninsurance, diabetes, non-primary English language, and large-city residence, influencing screening probabilities.
Conclusions:
- Patient engagement with SMS reminders is a significant mediator for cancer screening completion.
- Increasing SMS message interactivity may enhance cancer screening uptake.
- Theory-informed interactive messaging holds promise for improving patient engagement in cancer screening.
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