Does the Wording of Text Message Reminders Improve Uptake in Breast Screening? A Randomised Controlled Trial
Trial Snapshot
- Phase
- Not Applicable
- Status
- Terminated
- Enrollment
- 7,944
- Locations
- 1
- Primary Endpoint
- Uptake of the timed appointment provided by the screening service
Study Overview
Brief Summary
Breast screening is a service offered by the NHS to help detect breast cancer and precancerous changes early at a time when treatment is more likely to be curative. An effective service must reach the 'at risk' but asymptomatic population. Breast screening uptake in London, consistently falls below the national target and is well below the national average. Uptake in West London is particularly low, with boroughs in Inner North West London having the some of lowest uptake rates in the country.
Routine text message reminders have proven effective at improving uptake of breast screening appointments. However little attention is paid to the content of the messages. Previous studies of text message reminders in other clinical areas have shown that the content of these messages matters and some text messages are more effective than others.
This protocol describes the design of a randomized controlled trial to investigate the effect of differently worded text messages on the engagement with breast screening in West London.
Two intervention arms were designed taking into consideration results of a 1000 woman survey to highlight the behavioural barriers that most predict attendance. The survey tested 15 behavioural constructs and the two that most strongly predicted history of attendance were used to inform the text message content of the intervention arms for this trial.
To this end, this randomised controlled trial (RCT) will test the current standard practice text message reminder against two intervention text message trial arms informed by the above described survey.
The setting is West of London Breast Screening Service and women aged 47-73 who are due for screening will be randomized to receive one of the three trial arms.
The primary outcome is the difference in uptake between trial arms. Further statistical analysis will analyse the difference in uptake by age group, deprivation score and previous attendance status.
Result will inform how small changes to the word content may have significant effects on attendance at screening mammogram appointments.
Detailed Description
Background
In the UK breast cancer is the most common female cancer affecting 1 in 8 women, accounting for 31% of all cancers and 15% of cancer deaths in women.1 The NHS breast screening programme (NHSBSP) offers 3-yearly screening to women aged 50-70 years. A pilot of extended screening ages of 47-73 is being trialed in some geographical areas.
In 2015, 75% of women in England attended breast screening. In the same year only 68.3% of women in London and 65.9% in West London respectively had an up-to-day mammogram in the previous 3 years. 2 This falls below both the national average and target uptake of 70%. The success of a screening programme not only relies on the sensitivity of the screening tool and availability of successful treatment but also on reaching the asymptomatic but at risk population.
Recent evidence in breast screening has shown that a simple text message reminder (TMR) is effective. 3,4. One randomized controlled trial showed an increase in attendance by as much as 12%.5 As a result TMRs are being used more frequently by NHS organisations, but with little consideration paid their word content.
Further research testing the word content of TMR to remind patients of routine outpatient hospital appointments has shown that the word choice matters. The most effective message reduced 'did not attend' rates by 3.4 percentage points compared to a control TMR at a London Hospital. 6
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Single Group
- Primary Purpose
- Screening
- Masking
- Double (Participant, Care Provider)
Eligibility Criteria
- Ages
- 20 Years to 100 Years (Adult, Older Adult)
- Sex
- Female
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Women who are eligible and due for breast screening in West London.
Exclusion Criteria
- •Women who are not eligible for breast screening due to for example bilateral mastectomies.
- •Women who have chosen to not have screening and have informed the screening centre or their GP.
Arms & Interventions
Control
The current standard care text message reminder (SMS) that women routinely receive when being invited for their breast screening mammogram will be sent to the control group at 7 and 4 days before their timed appointment.
Intervention A - Behavioural Regulation
Intervention A will be a text message reminder (SMS) containing a behavioural regulation message. Women will be sent this SMS at 7 and 4 days prior to their timed appointment.
Intervention: Intervention A - Behavioural Regulation (Other)
Intervention B - Priority
Intervention B will be a text message reminder (SMS) containing a priority message. Women will be sent this SMS at 7 and 4 days prior to their timed appointment.
Intervention: Intervention B - Priority (Other)
Outcomes
Primary Outcomes
Uptake of the timed appointment provided by the screening service
Time Frame: Usually within a month (Individual timed appointment is provided by the screening service)
Each patient is invited to an individual timed appointment. The outcome measure will be assessed based on if women attend their timed appointment. Usually this is within a month of the invitation letter being sent.
Secondary Outcomes
- Uptake of time appointment by age group(Usually within a month (Individual timed appointment is provided by the screening service))
- Uptake of timed appointment by number of previous invitations received(Usually within a month (Individual timed appointment is provided by the screening service))
- Uptake of timed appointment by history of attendance(Usually within a month (Individual timed appointment is provided by the screening service))
- Uptake of timed appointment by deprivation score(Usually within a month (Individual timed appointment is provided by the screening service))