Mobile messenger-initiated reminders improve longitudinal adherence in a community-based, opportunistic colorectal cancer screening program: A single-blind, crossover randomized controlled study.
BACKGROUND
The fecal immunochemical test (FIT) is a cost-effective colorectal cancer (CRC) screening tool. However, longitudinal adherence, a factor that is critical to the success to any FIT-based screening program, often is poor. The authors hypothesized that reminders sent via mobile messengers, such as WhatsApp, improve such adherence.


METHODS
In the current single-blind, randomized study, subjects from an opportunistic FIT screening program who had a negative FIT result the year prior were randomly allocated (1:1) to receive either a 1-off reminder via the WhatsApp messenger (WR) 1 month prior to the due appointments or no reminder (NR). All subjects were blinded to study participation and group allocation. At 24 months after randomization, a crossover of intervention was performed among those individuals who remained in the FIT program. The primary outcome was FIT adherence, defined as the pick-up and on-time return of the FIT. The secondary outcome was FIT adherence after the crossover.


RESULTS
A total of 500 subjects were randomized to receive WR (250 subjects) or NR (250 subjects). Three individuals were excluded from analysis (1 died and 2 underwent colonoscopy). Both the FIT pick-up rate (80.3% vs 59.3%; P < .001) and return rate (79.9% vs 57.3%; P < .001) were significantly higher in the WR group compared with the NR group. After crossover of intervention (452 subjects), the WR group again was found to have a higher FIT pick-up rate (79.1% vs 52.9%; P < .001) and return rate (78.2% vs 52.4%; P < .001).


CONCLUSIONS
Text reminders sent via mobile messenger appear to improve the longitudinal adherence to FIT-based opportunistic CRC screening programs. The routine use of this technology in CRC screening should be considered.
['Lam|Thomas Y T|TYT|0000-0002-4306-4990', 'Wu|Peter I|PI|', 'Tang|Raymond S Y|RSY|', 'Luk|Arthur K C|AKC|', 'Ng|Simpson|S|', 'Sung|Joseph J Y|JJY|']
D000368:Aged D015179:Colorectal Neoplasms D018592:Cross-Over Studies D055088:Early Detection of Cancer D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009780:Occult Blood D010349:Patient Compliance D016037:Single-Blind Method D060145:Text Messaging
colorectal neoplasms compliance mass screening smartphone telemedicine