Health Message Framing to Improve Uptake of Bowel Cancer Screening

A national register exists for GP practices to identify which patients of theirs have or have not participated in a national bowel cancer screening programme. A sample of 1600 patients belonging to a particular practice in Scotland aged between 50 and 74 have been identified as having received the test kit but have not responded to it. These individuals have also previously consented to being contacted by the practice via phone text/SMS message for reminders.

The sample will be randomised into three equally populated groups:

• One group will act as the control arm and will receive no text message.
• One group will receive a text message which encourages participation in the screening programme and provides information on the cost of not participating (negative frame) - "If you do not take part in screening then you increase the risk of having an undiagnosed tumor."
• One group will receive a text message which encourages participation in the screening programme and provides information on the benefit of participating (positive frame) - "If you take part in screening then you decrease the risk of having an undiagnosed tumor."

Both text messages will include a weblink which will direct individuals receiving the text to find more information and also with instructions on how to order another kit should they have misplaced the kit that was mailed out to them.

The observation period will last 6 months and patients receiving the text will receive 3 texts in total. One at the start of the 6 months and another every two months after that. These messages will not change or alternate, that is the negatively framed group will receive the same text once every 2 months on 3 occasions in total and vice versa. Other studies have used shorter intervals between text messages to encourage change, although 6 months to 1 year is a standard amount of time overall. The researchers feel that while more regular messages may be more likely prompt behaviour there is also a risk of over-burdening the patient with reminders, as such 3 texts over 6 months was decided upon as a reasonable frequency.