‘WhatsApp’ Text Message Reminder Improves Adherence to Long-Term Screening for Colorectal Cancer

Participants who received a text message reminder about their fecal immunochemical test, a cost-effective colorectal cancer screening tool, were more likely to schedule, pick up the test kit, and complete and return it, compared with participants who did not receive a text message reminder, according to data presented in Cancer.

As one of the recommended screening options for colorectal cancer, the fecal immunochemical test comes at a low cost with high sensitivity, but often has poor longitudinal adherence – which included scheduling the screening test, as well as pick-up and completion of the test – a factor critical to the success of the test. Previously, conventional mail, calls and other message services have seen success but are not cost-effective.

Therefore, the researchers sought to discover if a text message reminder using “WhatsApp,” a free-to-use messenger application, would improve this poor long-term adherence.

“Because an inverse relationship exists between fecal immunochemical test adherence colorectal cancer related mortality, it is of clinical importance to implement effective strategies that optimize longitudinal fecal immunochemical test adherence,” the authors wrote.

In this single-blind, randomized study using an opportunistic fecal immunochemical test screening program, there were 500 participants, of which the majority were men, at a mean age of 57, who had a negative test results the year prior to the study taking place between June and Nov. 2017.

There were 249 participants who received a “WhatsApp” reminder one month prior to their screening test pick-up date. The reminder consisted of the benefits of screening, their pick-up date and hours of operation at the pick-up location. The remaining 248 participants received standard care, meaning no text message reminder prior to test pick-up. Both groups received a phone call reminder to drop off their completed test if they had not already.

Out of those who received the reminder text, 200 participants (80.3%) went to pick up their test, compared with 147 participants (59.3%) who did not receive a text message reminder. Not only was there a significantly higher rate of pick-up for those who received a reminder, but there was also a higher rate of returning the completed kit as well: 199 participants (79.9%) compared to 142 participants (57.3%).

Two years after participants were randomized to an intervention, individuals who remained eligible for the program (452 participants) crossed over to the other intervention. After the crossover, 225 participants received the text message reminder and 227 participants received standard of care with no reminder. Those who received the text messages showed significantly higher rates to not only pick up the test (178 participants [79.1%] versus 120 participants [52.9%], respectively), but also return it (76 participants [78.2%] versus 119 participants [52.4%]), compared to participants who did not receive a reminder.

Interestingly, the “WhatsApp” messenger reminder was most effective in males, those aged younger than 65 years and in participants with a family history of colorectal cancer; however, the researchers observed that the reminder did not improve adherence for those over the age of 65 years.

“This observation suggests that proficiency with smartphone applications may influence the effectiveness of such a reminder strategy,” they wrote.

The researchers suggested that this routine in colorectal screening should be considered further, not only because it worked, but it is also cost-effective. However, they noted, it might not be the most popular in all countries.

“Furthers studies would be needed to investigate the acceptability of different mobile messengers among screening program organizer and their target population,” the researchers concluded.

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