Health Serv Res. 2026 Jun;61(3):e70134. doi: 10.1111/1475-6773.70134.
ABSTRACT
OBJECTIVE: To examine how patient engagement with SMS text reminder scan mediate cancer screening completion among patients at Federally Qualified Health Center clinics (FQHCs).
STUDY SETTING AND DESIGN: Patients overdue for cancer screening were randomly assigned to one of two groups: a 3-week interactive SMS intervention or a 6-week theory-informed SMS intervention. The binary outcome was cancer screening completion after 90 days of SMS intervention. A mediation model was used to assess associations between text-message response rates and cancer screening completion. Exposure variables included sociodemographic characteristics, type of SMS intervention, type of cancer screening needed, and health status variables.
DATA SOURCES AND ANALYTIC SAMPLE: Data were obtained from two large FQHC networks in Texas and California in 2023. We included 4,344 patients who participated in the 3-week or 6-week intervention groups, successfully received all interactive messages, had unique phone numbers, and did not opt out of the intervention.
PRINCIPAL FINDINGS: Overall effects were statistically significant, indicating partial mediation. Full mediation was observed for insurance type: compared with Medicaid, private insurance was associated with a 5-percentage-point (PP) higher predicted probability of screening completion (Average marginal effect [AME] = 5.0 PP, 95% CI [0.01, 0.09]). Partial mediation was observed for Medicare (AME = 7.0 PP, 95% CI [0.02, 0.13]), uninsurance (AME = 5.0 PP, 95% CI [0.01, 0.09]), patient with diabetes (AME = -4.0 PP, 95% CI [-0.08, -0.01]), non-primary English language (AME = 8.0 PP, 95% CI [0.05, 0.10], p < 0.001), and large-city residence (AME = 9.0 PP, 95% CI [0.07, 0.10]), all of which were associated with higher predicted probabilities of screening completion.
CONCLUSIONS: Engagement with SMS reminders was a significant mediator of cancer screening completion, suggesting that increasing message interactivity may improve cancer screening uptake. Theory-informed interactive messaging may promote greater patient engagement.
PMID:42206315 | DOI:10.1111/1475-6773.70134
