Phone Calls Outperform Text Messages in Reminding Patients of Colon Cancer Screenings

As health systems look more to automated, digital reminder systems to keep patients engaged in their treatment, more traditional forms of communication might work best.

A new study from the Kaiser Permanente Center for Health Research found that live phone calls yielded significantly better returns than text messages when it came to prompting patients to complete at-home colon cancer screening tests.

The study included 2,700 patients from the Sea Mar Community Health Centers in Seattle, Washington. Only 10% returned their mailed tests within 3 weeks. The rest were placed into 1 of 7 different intervention tracks: a live phone call from a clinic outreach worker, 2 automated calls, 2 text messages, a single reminder letter, or a combination of these strategies.

Even the single reminder letter did better than text messages. Granted, the cohort was older, as patients for whom colon cancer screening is recommended are typically between the ages of 50 and 75. But even the researchers found the disparity shocking.

"We knew that these patients are not as text savvy as younger patients, but we didn't expect text messaging to do so poorly, compared to the other strategies," lead author Gloria Coronado, PhD, said in a statement.

Although text reminders are often attractive because they are inexpensive and require little of the provider, they were ineffective in the study. Roughly 32% of patients who received live phone calls returned their test kit within 6 months, nearly doubling the 17% on the text-only track in that time period.

Patients in the study received communications in either English or Spanish. There was a divide found in receptivity to the automated calls: Although phone calls were the most effective reminder method, Spanish-speaking patients were more likely than English speakers to respond to automated calls.

The study’s findings are food for thought for health systems trying to intervene in their patients’ health outside of the clinic. The cheapest and newest option is not necessarily the best, the report suggests, and those with different cultural experiences may need to have differently-tailored intervention communications.

“Our study shows that one reminder intervention doesn’t necessarily work for all patients. We need to design interventions tailored to the patient’s language and cultural preference,” Coronado explained.