A randomized trial led by researchers at the University of Pennsylvania Health System has shown that simple behavioral nudges—such as text message reminders and mailed letters—significantly improve participation in mailed colorectal cancer (CRC) screening programs.
The pragmatic study, published in Clinical Gastroenterology and Hepatology, enrolled 5,244 adults aged 50–74 who were overdue for CRC screening. Participants were mailed fecal immunochemical test (FIT) kits and randomly assigned to different outreach strategies:
- A branded blue box versus a standard envelope for packaging
- Text message reminders versus none
- Mailed reminders signed by primary care physicians versus none
Key Findings
- Text messages increased FIT completion by 6.6 percentage points (21.2% vs. 14.6%), while mailed reminders improved completion by 4.8 percentage points (20.3% vs. 15.5%).
- The branded box showed no effect compared with the plain envelope.
- Overall, patients who received outreach were four times more likely to complete screening than those in clinics without outreach (21.6% vs. 5.5%).
- Among those who tested positive, 61% completed follow-up colonoscopy, with more than half found to have adenomas.
Why It Matters
The findings underscore that low-cost, behaviorally informed communication—like text nudges and mailed letters—can drive meaningful improvements in preventive screening uptake.
Fancy packaging, however, adds cost without benefit.