Which is more effective at improving uptake of bowel cancer screening: text message reminders or patient navigation? Results from a three-arm RCT

Background Text message reminders (TMRs) and patient navigation (PN) increase bowel cancer screening uptake. To date, no studies have directly compared these interventions with one another. Methods We conducted a three-arm randomised controlled trial with individuals, in London, who had not completed bowel cancer screening within 18 weeks of invitation. Participants were randomised to receive no reminder (usual care), TMRs at 19, 21, 23 and 25 weeks, or a TMR at 19 weeks, with telephone PN at 21, 23 and 25 weeks. The primary outcome was participation within 26 weeks of invitation. Differences were assessed using logistic regression. Results On an intention-to-treat basis ( n = 3129), uptake was higher in the TMR and PN groups, compared with usual care (6.5% vs. 2.0%, p < 0.001; 7.5% vs. 2.0%, p < 0.001). There was no significant difference between TMR and PN groups. In the per-protocol analysis ( n = 2294), uptake was significantly higher in the PN group than the TMR group (8.6 vs. 12.6%, p < 0.025). Subgroup analyses revealed telephone PN was significantly more effective than TMRs for men, specifically (14.5% vs. 6.7%, p < 0.001). Conclusions While TMRs are no more effective than PN in general, implementing PN could help reduce disparities in uptake between men and women. Trial registration ISRCTN17245519.