Embedding Video Guidance in CRC Screening Reminders Fails to Increase FIT Return Rates

Colorectal cancer is the second-leading cause of cancer-related mortality in the United States, with screening strategies such as fecal immunochemical testing (FIT) offering a scalable, noninvasive approach for early detection.

Within mailed FIT outreach programs, patient reminders have consistently improved return rates, including those delivered via text messaging. Prior research has also suggested that video-based education can enhance screening uptake when delivered through various modalities.

A recent study by Petrik and colleagues evaluates whether combining these two approaches, specifically embedding an instructional video within a text message, confers additional benefit over text messaging alone.

Study Design and Population

This randomized study was conducted within Kaiser Permanente Northwest, an integrated health system serving approximately 650,000 members. Eligible participants were adults aged 45 to 75 years who were due or approaching due status for colorectal cancer screening. Individuals with conditions that would preclude FIT screening, including prior colorectal cancer or certain chronic diseases, were excluded.

Participants were randomized into two groups. One group received a standard text message notifying them that a FIT kit had been mailed, while the second group received the same message along with a link to a brief animated instructional video explaining how to complete the test. Both interventions were delivered concurrently with mailed FIT kits across four distribution waves in March and April 2023.

The final analytic cohort included 12,346 patients, with 6,156 in the text-only group and 6,190 in the text-plus-video group. Baseline characteristics were closely balanced between groups. Nearly 80 percent of participants were between ages 45 and 65, 52 percent were female, and approximately 48 percent had never previously completed colorectal cancer screening. The majority of participants were English-speaking and identified as White, and over 90 percent had continuous health plan enrollment in the prior year.

Intervention Exposure and Engagement

The instructional video, approximately two minutes in length, was delivered via a link embedded in the text message. It provided step-by-step guidance on completing the FIT kit and was available in both English and Spanish. Delivery systems included text messaging and, when necessary, interactive voice response calls for patients without valid mobile numbers.

Engagement data indicated limited interaction with the video. During the evaluation period, there were 146 total video views and 90 unique viewers, with most views occurring on mobile devices. These figures represent a small fraction of the intervention group, although the study could not confirm whether all recipients received or accessed the video link.

Primary Outcomes

The primary outcome was FIT completion at 90 and 180 days following randomization. Time-to-event analysis using Kaplan–Meier methods showed similar completion trajectories between groups over the 180-day period, with approximately 60 percent of patients in both groups returning their FIT kits by the end of follow-up.

Cox regression analysis demonstrated no statistically significant difference in FIT completion between the two groups. At 90 days, the hazard ratio for completion in the text-plus-video group compared with text alone was 1.02 (95 percent CI, 0.96 to 1.07; P = .54). At 180 days, the hazard ratio was 1.00 (95 percent CI, 0.96 to 1.06; P = .78).

Age was the only covariate significantly associated with FIT completion. Patients aged 55 to 65 were less likely to complete testing compared with those aged 45 to 55, while patients aged 65 and older were more likely to complete testing at both time points.

Interpretation of Findings

The results show that embedding a single instructional video within a text reminder did not improve FIT return rates compared with text messaging alone. The absence of effect occurred despite a large sample size and consistent delivery of mailed screening kits. Limited observed engagement with the video introduces uncertainty regarding actual exposure to the intervention, and the inability to verify whether patients opened or viewed the video constrains interpretation of the intervention’s effectiveness.

Reference:
Petrik AF, Mosen D, Singh C, et al. Comparative effectiveness of text + video vs text alone to prompt stool-based testing for colorectal cancer screening. Perm J. 2025;29:25.069. doi:10.7812/TPP/25.069