Text Message Campaign Reached Only a Third of Patients Overdue for Colorectal Cancer Screening

A quality improvement study at a US healthcare system found that a text messaging campaign designed to close colorectal cancer screening gaps reached only about a third of the primary care patients it targeted, and that response rates varied measurably by age, sex, marital status and race. Among 11,108 adults aged 45 to 75 who were identified in the electronic medical record as average risk for colorectal cancer, overdue for screening, and had visited a primary care clinic in the health system within the past year, 3,473 patients — 31.3 percent — responded to the initial text message with information about their screening history. The findings, published in BMC Primary Care, suggest that while text outreach can engage a broad primary care population, its reach was not equitable across patient groups.

The intervention asked patients to verify whether they were due for colorectal cancer screening. Those who confirmed they were due could then select a preference among three options: a direct referral for colonoscopy, an at-home Cologuard stool-based test, or a call from a care coordinator. The study’s primary outcome was the reach of the text messages, defined as the total number of patients who responded divided by the total number who received the message. Secondary outcomes assessed differences in response patterns and explored associations between patient characteristics and preferred screening type. The researchers used adjusted logistic regression models with backwards selection to identify associations between sociodemographic factors and patient responses.

The regression analysis revealed several statistically significant patterns in who replied. Older patients had lower odds of responding, with an odds ratio of 0.99 per year of age (95 percent confidence interval 0.98 to 0.99), and single patients also had lower odds of response (odds ratio 0.88, 95 percent confidence interval 0.80 to 0.98). Conversely, female patients had higher odds of responding than male patients (odds ratio 1.34, 95 percent confidence interval 1.23 to 1.46), and Black patients had higher odds of response than white patients (odds ratio 1.14, 95 percent confidence interval 1.04 to 1.25). Because these are odds ratios from an observational quality improvement dataset, they describe associations within this campaign rather than causal effects of the characteristics themselves.

Among the 1,907 patients who indicated through the text exchange that they were due for screening, 1,319 requested a referral for a screening test or a connection to a care coordinator. Preferences were split across the three pathways: 35.9 percent requested a direct referral to colonoscopy, 38.4 percent requested Cologuard, and 25.6 percent asked to be connected to a care coordinator. The substantial share choosing care coordination suggests that a meaningful portion of patients overdue for screening need human navigation rather than an automated referral, even within a digital-first outreach program.

The authors conclude that text messaging interventions can be an effective strategy for reaching a broad primary care population about colorectal cancer screening, but that reach was not equitable. They note that future work should explore how intentional strategies related to timing or language could mitigate gaps in engagement with text outreach, identify where care coordination is needed, and assess whether such campaigns ultimately improve colorectal cancer screening completion. As a single-system quality improvement study describing reach and response patterns rather than screening outcomes, the findings characterize who engaged with this particular campaign and do not by themselves establish that text outreach raises completed screening rates.

Subject of Research: Patient responses to a text messaging campaign to increase colorectal cancer screening among overdue primary care patients

Article Title: Patient response to a text messaging campaign to close colorectal cancer screening care gaps among primary care patients

Article References: Schubel, L. C., Mongraw-Chaffin, M., Ratwani, R., Atkinson, A., Brennan, D., Daughtry, M., & Arem, H. (2026). Patient response to a text messaging campaign to close colorectal cancer screening care gaps among primary care patients. BMC Primary Care. https://doi.org/10.1186/s12875-026-03632-8

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03632-8

Keywords: colorectal cancer screening, text messaging, primary care, digital health, health equity, care coordination, quality improvement, Cologuard, colonoscopy, patient engagement, electronic medical records, Patient