Behavioral economics informed message content in text message reminders to improve cervical screening participation: Two pragmatic randomized controlled trials

Sarah Huf, Robert S. Kerrison, Dominic King, Tim Chadborn, Adele Richmond, Deborah Cunningham, Ellis Friedman, Heema Shukla, Fu Min Tseng, Gaby Judah, Ara Darzi, Ivo Vlaev*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

The objective of the reported research was to assess the impact of text message (SMS) reminders and their content on cervical screening rates. Women invited for cervical screening in Northwest London from February–October 2015 were eligible. 3133 women aged 24–29 (Study 1) were randomized (1, 1) to ‘no SMS’ (control), or a primary care physician (PCP) endorsed SMS (SMS-PCP). 11,405 women aged 30–64 (Study 2), were randomized (1, 1:1:1:1:1:1) to either: no SMS, an SMS without manipulation (SMS), the SMS-PCP, an SMS with a total or proportionate social norm (SMS-SNT or SMS-SNP), or an SMS with a gain-framed or loss-framed message (SMS-GF and SMS-LF). The primary outcome was participation at 18 weeks. In Study 1 participation was significantly higher in the SMS-PCP arm (31.4%) compared to control (26.4%, aOR, 1.29, 95%CI: 1.09–1·51; p = 0.002). In Study 2 participation was highest in the SMS-PCP (38.4%) and SMS (38.1%) arms compared to control (34.4%), (aOR: 1.19, 95%CI: 1.03–1.38; p = 0.02 and aOR: 1.18, 95%CI: 1.02–1.37; p = 0.03, respectively). The results demonstrate that behavioral SMSs improve cervical screening participation. The message content plays an important role in the impact of SMS. The results from this trial have already been used to designing effective policy for cervical cancer screening. The NHS Cervical Screening Programme started running a London-wide screening SMS campaign which was based on the cervical screening trial described here. According to figures published by Public Health England, after six months attendance increased by 4.8%, which is the equivalent of 13,400 more women being screened at 18 weeks.

Original languageEnglish
Article number106170
JournalPreventive medicine
Volume139
DOIs
Publication statusPublished - Oct 2020

Bibliographical note

Funding Information:
Robert Kerrison was supported by a Cancer Research UK Population Research Fellowship [ C68512 / A28209 ].

Funding Information:
Infrastructure support for this research was provided by the NIHR Imperial Biomedical Research Centre (BRC) and the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre. The grant reference for the Imperial BRC is 1215-20013. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Funding Information:
This study was partly funded by a Special Purpose Fund awarded by Imperial Health Charity [Ref: 7006/P26U ].

Funding Information:
Ivo Vlaev was supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Funding Information:
This study was partly funded by Public Health England as a Behavioral Insights Project.

Funding Information:
Infrastructure support for this research was provided by the NIHR Imperial Biomedical Research Centre (BRC) and the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre. The grant reference for the Imperial BRC is 1215-20013. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Ivo Vlaev was supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Robert Kerrison was supported by a Cancer Research UK Population Research Fellowship [C68512/A28209]. This study was partly funded by a Special Purpose Fund awarded by Imperial Health Charity [Ref: 7006/P26U]. This study was partly funded by Public Health England as a Behavioral Insights Project. We thank iPLATO for the very helpful support.

Publisher Copyright:
© 2020 Elsevier Inc.

Keywords

  • Behavior change
  • Behavioral economics
  • Cervical screening
  • Health message content
  • Nudge
  • SMS reminders
  • Text-message reminders

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