Setting the direction for mobile messaging in population screening

A woman using a mobile phone, demonstrating how text messaging can be used in population screening

Mobile messaging has now become an essential tool to help healthcare services communicate and connect with patients. In a recent US study, 70.5% of patients surveyed used a form of text messaging to manage their general health. Not only are these messages a cost-effective, and convenient way of communicating, but they are also extremely versatile. In addition to reminding patients about upcoming appointments, they can be used to give endorsement, by highlighting your GP “recommends regular screening as an important health check” or to give medical updates. The latter was crucial during COVID-19 when access to physical services was limited.

Unique problems with population screening

It would seem that all aspects of healthcare should be making free use of mobile messaging, and by in large that is true. However, population screening programmes bring about some unique challenges. The aim of screening is to find a condition at an early stage before symptoms are noticed, meaning treatment is more likely to be successful. Unlike GP or hospital appointments, people may therefore not necessarily be expecting to be contacted. As not all screening services are run through GPs, invited individuals may also be contacted by a service they do not know or have never been involved with beforehand.

Screening services must also send messages to thousands of people, each with different communication needs and expectations. Finally, attending screening is an individual’s choice, so it’s important that services respect this and do not come across pushy or coercive when contacting the public. In fact, in one of the patient and public groups I spoke at, one of the participants said, “that’s the reason I didn’t go – it seemed like they were ordering me to go”.

An old technique but new directions

To help screening services overcome these issues, in September 2020 Public Health England (PHE) published their first guidance piece: Screening text message principles. This work used the available evidence to provide initial recommendations on how screening services could implement mobile messaging. However, SMS is a 30-year-old technology and new messaging tools including apps, which offer a wider range of features, are becoming more common.

While it’s important to consider some of these features, so too is it necessary to consider less thought about areas such as how research in this area should be conducted. Working with PHE, our IGHI team led by Professor Darzi including myself, Viknesh Sounderajah, Gaby Judah and Hutan Ashrafian, updated this guidance from PHE to include new directions and research areas.

Our project: The SMS and mobile messaging In Population Screening (SIPS) study

Much of the focus of mobile messaging in healthcare is on wording. But there is a lot more to consider. We were also conscious when designing this project that each screening programme (there are 11 adult programmes currently running), will have its own needs and specifications.

To address these issues we invited experts from a range of different but related fields including screening services, public health, academia, and industry to help create recommendations for NHS screening services in six key areas:

1. Content
2. Timing
3. Security & Governance
4. Evaluation
5. Delivery
6. Research & Future considerations

These experts considered over 100 potential recommendations, which were designed with the help of a large public involvement group, specialist government departments (e.g. National Cyber Security Centre) and their own experiences. By repeatedly voting on what experts felt was important while considering the evidence provided to them, and then discussing this voting, we created a list of core items we recommend for screening services. These include keeping messages at a reading level of 9 years old, and ensuring messages are as close to 320 characters in length as possible. In addition, we also developed a list of desirable items which screening programmes may look to in the future, including the availability of translations for those who do not have English as a first language.

How does this affect patient care?

The public are essential stakeholders in projects like ours, as ultimately they are the ones who receive these messages. Our project started with a large patient group and considered what is important to them. From there, with experts we began developing the recommendations. We hope through this process, we will be able to improve communication between screening services and the public. This will ensure that services develop messaging that can facilitate the screening process, which can be daunting sometimes. In this way they potentially may better meet the needs of the patients they invite now and as technologies advance.

What next?

The updated guidance has now been published on the GOV.UK website. You can also follow updates on our project page.

Dr Amish Acharya is a Clinical Research Fellow at the Institute of Global Health Innovation

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