Text message reminders boost cervical screening uptake

Sending a text message reminder can lead to more women taking up cervical screening, new research has shown.

In a study of almost 15,000 women in Northwest London, SMS reminders increased cervical screening participation by around 5%.

Based on these findings, the NHS rolled out text message reminders across London in late 2018 for a 6-month trial period, which saw a similar rise of 4.8% in cervical screening uptake. That is the equivalent of 13,400 more women being screened as a result of the campaign.

"Given the likely detrimental impact of the ongoing COVID-19 pandemic on cancer screening rates across the UK, simple interventions such as text message reminders could support efforts to increase cervical screening as services resume normal practice." Dr Sarah Huf Honorary Clinical Research Fellow, IGHI

The research, led by Imperial College London’s Institute of Global Health Innovation (IGHI), has been published in the journal Preventive Medicine.

Cervical screening can help save lives by spotting harmful or potentially harmful changes in cervical cells earlier, meaning women can get access to treatment when it’s more likely to be effective. This means that cervical screening can lead to better outcomes for women, as well as helping to prevent cervical cancer.

But cervical screening rates have been falling in Britain. To address this, a team from Imperial, Public Health England, Warwick Business School, UCL and Imperial College Healthcare NHS Trust explored whether sending a text to remind women that their smear test is due could encourage more people to make and attend an appointment.

A low-cost intervention

14,500 women aged 24-64* years participated in the study, which ran from February-October 2015, supported by the London Borough of Hillingdon CCG, and participating GP practices. The researchers tested a number of different text messages to find out whether the specific content could make a difference to attendance rates. These included:

• standard reminders to book an appointment;
• messages that were endorsed by the participants’ GP practice;
• texts that highlighted potential benefits of screening or costs of not being screened (the number of lives that screening saves, or number of lives lost if not screened, each year);
• messages relaying the local proportion, or number of women being screened (social norms).

The messages were sent using the help of iPlato. More women in the trial attended cervical screening if they received a text message, compared to those who didn’t. Rates were highest in those who received a standard reminder or a GP-endorsed text, both of which saw around a 5%** increase in participation.

Slightly more women also attended screening if they were sent a text framed around potential losses or gains, but attendance was not significantly higher than for those who were not sent a text message. But when the researchers excluded cases where the text was not successfully sent (determined from delivery status information), the study found that uptake was higher across all of the different SMS messages, compared to no message.

Dr Sarah Huf, lead author and Honorary Clinical Research Fellow at IGHI, said: “Not only do text message reminders improve cervical screening rates, our results indicate that what we write in the message matters. We hope that this low-cost intervention will be adopted beyond London. Given the likely detrimental impact of the ongoing COVID-19 pandemic on cancer screening rates across the UK, simple interventions such as text message reminders could support efforts to increase cervical screening as services resume normal practice.”

"We’re delighted that our findings have already been implemented in a successful pilot campaign in London, which we hope will be extended so that more women can benefit from cervical screening, which we know saves lives." Dr Gaby Judah Lecturer in behavioural sciences, IGHI

Dr Gaby Judah, study author and Lecturer in Behavioural Sciences at IGHI, said: “Our study suggests that messages endorsed by a person’s GP can be effective at increasing cervical screening uptake, but also that a simple reminder can be as good as or better than many other type of messages that we studied.

“We’re delighted that our findings have already been implemented in a successful pilot campaign in London, which we hope will be extended so that more women can benefit from cervical screening, which we know saves lives. In order to make the most of the impact that SMS reminders can have on uptake, it will be important for services to have up-to-date phone numbers for their patients.”

As it costs around just £0.03 to send a text, SMS reminders would be a relatively inexpensive intervention for health systems. Although if practices don’t already have the required software, there are further costs attached to setting this up.

Professor Ivo Vlaev, study author from Warwick Business School, said: "We very much hope the rest of the country implements this revolutionary behavioural approach as soon as possible."

Based on the results of this study, the researchers are now extending their work to find out whether the specific wording of text message reminders can influence rates of breast screening.

Notes
* 3,133 women aged 24-29 were randomised to receive either no SMS, or an SMS endorsed by their GP (study 1). A further 11,405 women aged 30-64 were randomised to receive either no SMS, a standard SMS, an SMS endorsed by their GP, or one of four SMS’ with messages framed around social norms, potential losses or gains (study 2).
** In study 1, participation was higher in those who received a GP-endorsed SMS (31.4%) compared to those who received no SMS (26.4%). In study 2, participation was highest in those who received a GP-endorsed SMS (38.4%) or a standard SMS (38.1%), compared to no SMS (34.4%).