Text-based Intervention Increases Mammography Uptake among Overdue Patients at an Urban, Safety-Net Hospital: A Randomized Controlled Study

Abstract

Background Patients diagnosed with breast cancer at our safety-net hospital (SNH) are significantly more likely to be diagnosed at later stages, and this late-stage-at-diagnosis is most highly associated with lack of screening mammogram. We showed that a two-part intervention - phone call and assistance with scheduling - significantly increased mammography uptake by 12% among our safety-net population. Implementing this finding system-wide proved challenging and resource heavy. Prior studies show success with text message reminders in low-income populations, but none evaluate the utility of scheduling by text. Here, we seek to determine whether a text-based intervention with reminder and scheduling could increase mammography uptake. Methods A randomized controlled study included 843 women aged 50-65 who had not had a screening or diagnostic mammogram in the past two years, but had established care at a primary care clinic (PCC) within our SNH. One-third of the participants were assigned to each of the following groups: Intervention 1 (text reminder with specific scheduling options), Intervention 2 (text reminder with open-ended scheduling options) and usual-care control. Participants in both intervention groups could engage in two-way texting, and up to three texts were sent to each patient. Differences in percent mammography uptake at 3 months were compared between intervention and control groups using a two-tailed chi-square. Results Patients receiving a text-based reminder and scheduling opportunity were significantly more likely to get mammograms within 3 months than those in the usual care control group (10.2% and 6.2%, respectively; chi2 = 5.6279, p < 0.017). 14.8% of participants responded to text message. 9% of participants scheduled an appointment for mammogram via text, of which 63% received mammogram. Mammography compliance did not differ by type of scheduling offered (specific vs. general) or by PCC. Conclusion Reminders and scheduling through two-way text-messaging is effective in increasing mammography uptake among primary care clinic patients in an urban safety-net setting. Scheduling component was a key feature in the success of the intervention. The safety-net is a diverse and hard-to-reach population. Future studies should combine different types of interventions to design a multi-pronged approach that is tailored to this population with unique needs.