Are text message reminders an effective intervention to improve uptake of breast screening? A randomised controlled trial

Abstract

BackgroundBreast cancer is a major public health concern in the UK, one accounting for 16% of all cancer incidences and 7% of all cancer deaths. Fortunately, the natural history of this malignancy can be beneficially changed through the early detection and treatment of benign and malignant breast disease, which have been enabled by mammographic screening techniques. However, the success of screening programmes depends on their ability to attract the at-risk population, as well as the analytical specificity and sensitivity of the screening test itself. The NHS Breast Screening Programme attracts about three-quarters of the invited population each year. In 2010, all but one region reported a triennial coverage of more than 75%; London was the exception, reporting a regional coverage of 69%. London consistently fails to meet the national target. Missed appointments are a primary cause of inefficiency in health-care delivery, with adverse clinical implications for the non-attending patient and substantial monetary costs to the health service. To ensure the future success of the breast screening programme, development of strategies to improve uptake of hard-to-reach patients is imperative. Research has shown that receiving an appointment reminder by text message has been successful in reducing non-attendance in other areas of health care; the same might be true for breast screening. Our primary aim was to establish whether text message reminders can significantly improve the uptake of breast screening by women on an intention-to-treat basis in the London Borough of Hillingdon. Our secondary aim was to assess whether text message reminders are an effective intervention for improvement of uptake of breast screening by hard-to-reach patients such as women living in deprived areas and women of black and minority ethnic groups. MethodsWe undertook a single-blind, randomised controlled trial to assess the effectiveness of sending a text message appointment reminder 48 h before a patient's first breast screening appointment to improve uptake of the programme by prevalent women aged 47–53 years in the London Borough of Hillingdon. 1640 women without a history of breast screening, implant, or bilateral mastectomy were included in the study and randomly assigned (1:1) to either the control (n=833) or intervention (n=807) group. Women in the control group were invited to screening but received no reminder for their appointment, whereas women in the intervention group received a text message reminder 48 h in advance. All women received an information letter about the study with their invitation from the West of London Breast Screening Service. Patients were not told whether they would be receiving a text message reminder or not. iPlato Patient Care Messaging was used to deliver text message reminders. This trial is registered with ClinicalTrials.gov, NCT01977599. FindingsWomen in the text message reminder group were significantly more likely (odds ratio 1·32, 95% CI 1·12–1·53; p=0·0092) to attend their first breast screening appointment (69% uptake) than women in the control group (63% uptake). Of the 807 women assigned to the text message reminder group, only 316 (39%) had a valid mobile telephone number recorded on the GP Clinical System and were subsequently able to receive a text message reminder. Of the 316 patients who did receive a text message reminder, 252 (80%) attended breast screening. No adverse events were reported. These are preliminary data of an ongoing trial expected to be completed in September, 2013. Full results including deprivation and ethnic origin data will be available for the conference. InterpretationReceipt of a text message reminder 48 h before a scheduled breast screening appointment significantly improves uptake. To ensure that the benefits of text message reminders are achieved, work is needed to improve patient mobile records. FundingResearch funded by Imperial College Healthcare Charity.