Skip to main content

A study by University of North Carolina researchers demonstrated that text messaging is an effective and largely well-received tool to communicate about colorectal cancer screening and support key components of shared decision-making. The study’s findings were published May 5, 2023, in the Journal of Medical Internet Research Cancer.

Caption available
UNC Lineberger’s Jennifer Elston Lafata, PhD.

Soohyun Hwang, MPH, PhD, UNC Gillings School of Global Public Health, Jennifer Elston Lafata, PhD, UNC Eshelman School of Pharmacy and UNC Lineberger Comprehensive Cancer Center, and their colleagues assessed whether text messaging could raise awareness about colorectal cancer screening and encourage shared decision-making. They had a specific interest in determining the impact of this approach with people who have been marginalized because of low income, low literacy, or race.

The study enrolled 289 men and women aged 50-75 and who had no personal history of cancer. Of these participants, 115 reported having low income, 146 identified as Black/African American and 102 had less than extreme confidence in their health literacy. None reported a personal history of cancer (the age range corresponded with the U.S. Preventive Services Task Force screening recommendations for people with normal colorectal cancer risk when the survey was conducted July and August 2020; the task force now recommends that screening starts at age 45).

The text message program offered educational information on screening and focused on three of the most common components of shared decision-making: choice awareness, option awareness and decision-making.

Approximately 9 in 10 of the respondents found the program easy to use and beneficial to learn about screening. More than 7 in 10 of the respondents also thought it would help them decide (78.9%) or speak with their doctor about (73.7%) whether to undergo screening. Black/African American study participants were more likely than white participants to find the text messages useful in learning about colorectal cancer screening (93.7% compared to 83.2%), speaking with their doctors about screening (80.7% versus 63.7%) and deciding whether to be screened (82.1% versus 77%).

These findings, Lafata said, “suggest text messaging-based programs might enable health care organizations to reach broader populations than they could by relying solely on online patient portal, and they are particularly likely to be helpful in raising choice awareness in the context of shared decision-making.”


Authors and disclosures

In addition to Hwang and Elston Lafata, the paper’s other authors are Allison J. Lazard, PhD, and Meredith K. Reffner Collins, MA, Hussman School of Journalism and Media and UNC Lineberger; Alison T. Brenner, PhD, Seth D. Crockett, MD, MPH, and Daniel S. Reuland, MD, MPH, UNC School of Medicine and UNC Lineberger; Hillary M. Heiling and Allison M. Deal, PhD, UNC Lineberger.

The study was supported with a University Cancer Research Fund grant.