Abstract B009: ¡Salud!, por la Vida, an educational intervention to increase colorectal cancer screening in Puerto Ricans

Colón‐López, Vivian; Vélez-Álamo, Camille; Acevedo-Fontanez, Adrianna I; Soto-Salgado, Marievelisse; Rodríguez-Lebrón, Jorge L; Llavona-Ortiz, Josheili Y; Serra-Martínez, Yolanda; Valencia-Torres, Ileska; Fernández, M. Isabel

doi:10.1158/1538-7755.disp19-b009

Cited by 2 publications

(1 citation statement)

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“…In combination with the automated responses via text messages, fotonovelas were created to address barriers found in the literature such as procrastination, lack of self-care, lack of time, embarrassment about the process, and fear of results [ 20 - 25 ]. Fotonovelas were written in both Spanish and English, and each version contained a cast of either men or women for a total of 4 different fotonovelas.…”

Section: Methodsmentioning

confidence: 99%

Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation

Levitz¹,

Kuo²,

Guo³

et al. 2023

JMIR Cancer

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Background Colorectal cancer (CRC) is currently the second leading cause of cancer-related deaths in the United States; however, it is mostly preventable with appropriate screening and is often treatable when detected at early stages. Many patients enrolled in an urban Federally Qualified Health Center (FQHC) clinic were found to be past due for CRC screening. Objective This study described a quality improvement (QI) project to improve CRC screening rates. This project used bidirectional texting with fotonovela comics and natural language understanding (NLU) to encourage patients to mail fecal immunochemical test (FIT) kits back to the FQHC. Methods The FQHC mailed FIT kits to 11,000 unscreened patients in July 2021. Consistent with the usual care, all patients received 2 text messages and a patient navigator call within the first month of mailing. As part of a QI project, 5241 patients who did not return their FIT kit within 3 months, aged 50-75 years, and spoke either English or Spanish were randomized to either usual care (no further intervention) or intervention (4-week texting campaign with a fotonovela comic and remailing kits if requested) groups. The fotonovela was developed to address known barriers to CRC screening. The texting campaign used NLU to respond to patients’ texts. A mixed methods evaluation used data from SMS text messages and electronic medical records to understand the impact of the QI project on CRC screening rates. Open-ended text messages were analyzed for themes, and interviews were completed with a convenience sample of patients to understand barriers to screening and impact of the fotonovela. Results Of the 2597 participants, 1026 (39.5%) in the intervention group engaged with bidirectional texting. Participating in bidirectional texting was related to language preference (χ22=11.0; P=.004) and age group (χ22=19.0; P<.001). Of the 1026 participants who engaged bidirectionally, 318 (31%) clicked on the fotonovela. Furthermore, 54% (32/59) of the patients clicked on the fotonovela and responded that they loved it, and 36% (21/59) of patients responded that they liked it. The intervention group was more likely to get screened (487/2597, 18.75%) than those in usual care (308/2644, 11.65%; P<.001), and this pattern held, regardless of demographic subgroup (sex, age, screening history, preferred language, and payer type). Interview data (n=16) indicated that the text messages, navigator calls, and fotonovelas were well received and not unduly invasive. Interviewees noted several important barriers to CRC screening and offered suggestions for reducing barriers and increasing screening. Conclusions Texting using NLU and fotonovela is valuable in increasing CRC screening as observed by the FIT return rate for patients in the intervention group. There were patterns in which patients did not engage bidirectionally; future work should investigate how to ensure that populations are not left out of screening campaigns.

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Section: Methodsmentioning

confidence: 99%

Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation

Levitz¹,

Kuo²,

Guo³

et al. 2023

JMIR Cancer

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Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation (Preprint)

Levitz¹,

Kuo²,

Guo³

et al. 2022

Preprint

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BACKGROUND Colorectal cancer (CRC) is currently the second-leading cause of cancer death in the US; yet it is mostly preventable with appropriate screening and often treatable when found at early stages. Many patients within an urban Federally Qualified Health Center (FQHC) clinic were found to be out-of-date with screening guidelines and therefore not benefitting from screening. Texting campaigns and motivational fotonovelas comics have both showed promise to encourage prosocial behaviors in various contexts. OBJECTIVE This project sought to use tailored bidirectional texting with fotonovela comics to boost participation in a campaign to mail Fecal Immunochemical Test (FIT) colorectal cancer screening kits to patients. METHODS The clinic mailed FIT screening kits to 11,000 unscreened patients in July 2021. Consistent with usual care, all patients received two text messages and a patient navigator call within the first month of mailing. Three months after mailing the kits, 5,241 patients who did not return their FIT kit, were aged 50 to 75, and spoke either English or Spanish were randomized to either intervention (4-week tailored two-way texting campaign with a fotonovela comic and remailing kits if requested) or control (no further intervention). RESULTS 39.5% of intervention patients engaged with bidirectional texting, and they were on average younger (aged 50-60) and more likely to have commercial insurance than those who did not engage with bidirectional texting. Of the 1,026 who engaged bi-directionally, 31% clicked the fotonovela (12.2% of the intervention population). Patients in the 50-60 age group were more likely to click the fotonovela than those 61-75 (95% CI for difference of means 2.6% to 7.6%, P<.001). Patients who clicked on the fotonovela link generally reported enjoying it, with 54.2% of patients who rated the fotonovela responding that they loved it (n=32 of 59) and 35.6% saying they liked it (n=21 of 59). The intervention group was significantly more likely to get screened (18.8%, N=2,597) than controls (11.6%, N=2,644; P<.001), and this pattern held, regardless of demographic subgroup (gender, age, screening history, preferred language, and payer type). Data from qualitative interviews (N=16) indicated that generally the text messages, navigator calls, and fotonovelas were well received and not unduly invasive. Respondents noted several important barriers to CRC screening and had several suggestions for reducing barriers and increasing screening. CONCLUSIONS Texting with automated conversational responses to all eligible patients appears valuable in increasing CRC screening. Intervention participants had significantly greater rates of FIT return, regardless of demographic factors. A significant number of patients remained unscreened, underscoring the need for continued education and multi-level interventions to reduce barriers.

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Abstract B009: ¡Salud!, por la Vida, an educational intervention to increase colorectal cancer screening in Puerto Ricans

Cited by 2 publications

References 0 publications

Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation

Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation

Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation (Preprint)

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