Text Messaging and FIT Completion in a Quality Improvement Trial

Key Takeaways

• FIT completion within 21 days was higher in the text group than in the telephone group.
• Adults with new FIT orders at eight Brooklyn FQHCs were randomized 1:1 to three one-way texts on days 2, 5, and 8 or one nurse-led day-8 call.
• Post hoc analyses found no evidence of differential effectiveness by age, sex, race and ethnicity, or patient portal use.

Automated text reminders were associated with a 9.0-percentage-point higher FIT completion rate than nurse-led telephone outreach in a randomized quality improvement trial of automated text reminders for FIT completion. The comparison took place across eight federally qualified health centers in Brooklyn, New York. Adults with a new FIT order received automated one-way text reminders or a nurse-led reminder call after the order was placed.

This quality improvement randomized clinical trial ran from April 7 to June 24, 2025, within Family Health Centers at NYU Langone in Brooklyn, New York. The participating sites were eight Federally Qualified Health Centers serving adults who had newly received a FIT order. Eligible participants were aged 18 years or older, listed English, Spanish, or Chinese, either Mandarin or Cantonese, as a preferred language, and had not opted out of text messaging. Investigators randomized 1,275 participants in a 1:1 ratio, with 649 assigned to three automated one-way text reminders on days 2, 5, and 8 and 626 assigned to a single nurse-led telephone reminder on day 8.

By 21 days, FIT completion was documented for 382 of 649 participants in the text group and 312 of 626 participants in the telephone group. Completion rates on electronic health record assessment were 58.9% and 49.8%, respectively. The absolute difference was 9.0 percentage points, with a 95% CI of 3.6 to 14.5 percentage points. The reported P value was .001.

Post hoc analyses found no evidence that the relative effectiveness of texting differed by age, sex, race and ethnicity, or patient portal use. Because these analyses were exploratory, they did not establish subgroup-specific effects.

The authors interpreted automated messaging as a potentially scalable, low-cost approach that could support preventive care and reduce staff burden in underserved populations.