Translational Projects (Open Access)

Graduation Date

Spring 2023

Degree Name

Doctorate in Health Informatics (DHI)

School Name

McWilliams School of Biomedical Informatics at UTHealth Houston

Advisory Committee

Debora Simmons, PhD, RN, CCNS, FAAN


Meaningfully engaging with patients through technology is becoming increasingly important in healthcare. Mailed letters, phone calls, and even one-way text messaging or some combination of these have all been utilized to communicate with patients regarding preventative healthcare screening measures, with varying degrees of success. While many studies have examined the use of bidirectional text messaging (BTM) to engage patients regarding mammograms, cervical cancer screening, and other issues, very little literature exists on BTM concerning colorectal cancer (CRC).

Therefore, this project sought to examine the impact of BTM between two primary care clinics and their respective patients who were prescribed and received an at-home CRC screening test but had not returned the kit to be processed. The patients were sent BTM reminders at two-,four-, and six-weeks post-screening order. Following the pilot, pre-test and post-test analyses were conducted to determine the impact of BTM on return rates, response rates, and response-return relationships. In addition, a survey was distributed to providers to obtain their perspectives on the content and structure of the messages. All providers who were sent the provider survey responded.

We found that while there was a limited increase in the return rate throughout the pilot, most patients chose not to respond to any messages. Therefore, a relationship between responding to messages and returning the kit did not exist. Most patients who returned the kit during the pilot did so after the first text message, followed by a sharp decline after the second message and uptake after the third message. There was agreement among most providers regarding the structure and content of messages and why patients may have chosen not to respond to any messages.

To better understand the limited success of this project, we conducted a post-project analysis utilizing key concepts from implementation science frameworks. The resulting insights, including the need to understand the patient population and to include an informatics expert in all project phases, can inform future provider-to-patient communication projects within the parent organization for both clinics. Further evaluation is needed to determine the organizational impact and influence of technology-based communication projects in the context of preventative care.


bidirectional text messaging, colorectal cancer, CRC, screening



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