PRIMARY OBJECTIVES:
I. Maximize text message engagement for patients due for FIT screening in diverse patient populations.
II. In a multi-level trial, test the impact of optimized text messages in combination with different outreach elements and systems-level screening gap closure strategies on CRC screening outcomes.
III. Informed by Consolidated Framework for Implementation Research (CFIR) and the Integrated Sustainability Framework, evaluate the sustainment of the intervention by the CHCs over time, and identify implementation factors that support sustainability.
OUTLINE: Participants are assigned to 1 of 2 steps.
STEP 1: Patients are assigned to group I and CHC staff are assigned to group II.
GROUP I: Patients attend a focus group over 60 minutes on study to support the optimization of the text messages to maximize patient engagement and outreach.
GROUP II: CHC staff attend a key informant interview over 60 minutes on study to support the identification of the logistics of seamless intervention integration into routine clinical operations as well as perspectives on the intervention activities.
STEP 2: Patients are assigned to 1 of 2 aims.
AIM 1: Patients are randomized to 1 of 8 conditions.
CONDITION 1: Patients receive a standard Azara Patient Outreach (APO) text message on days 0 (day of the FIT order), 7, and 14.
CONDITION 2: Patients receive a text message which addresses negative emotions on days 0 (day of the FIT order), 7, and 14.
CONDITION 3: Patients receive a text message which addresses negative emotions and contains message framing on days 0 (day of the FIT order), 7, and 14.
CONDITION 4: Patients receive a text message which contains message framing on days 0 (day of the FIT order), 7, and 14.
CONDITION 5: Patients receive a text message which contains personalization on days 0 (day of the FIT order), 7, and 14.
CONDITION 6: Patients receive a text message which contains personalization and message framing on days 0 (day of the FIT order), 7, and 14.
CONDITION 7: Patients receive a text message which contains personalization and addresses negative emotions on days 0 (day of the FIT order), 7, and 14.
CONDITION 8: Patients receive a text message which contains personalization and message framing and also addresses negative emotions on days 0 (day of the FIT order), 7, and 14.
AIM 2: Patients are randomized to 1 of 8 conditions.
CONDITION 9: Patients receive a text message which contains the best-performing message series from Aim 1 on days 0 (day of the FIT order), 7, and 14.
CONDITION 10: Patients receive a text message focused on providing information about resources related to impediments to care on days 0 (day of the FIT order), 7, and 14.
CONDITION 11: Patients receive a text message focused on providing information about resources related to impediments to care and engaging trusted relationships on days 0 (day of the FIT order), 7, and 14.
CONDITION 12: Patients receive a text message focused on engaging trusted relationships on days 0 (day of the FIT order), 7, and 14.
CONDITION 13: Patients receive a text message focused on engaging autonomy on days 0 (day of the FIT order), 7, and 14.
CONDITION 14: Patients receive a text message focused on engaging autonomy and trusted relationships on days 0 (day of the FIT order), 7, and 14.
CONDITION 15: Patients receive a text message focused on engaging autonomy and providing information about resources related to impediments to care on days 0 (day of the FIT order), 7, and 14.
CONDITION 16: Patients receive a text message focused on engaging autonomy, providing information about resources related to impediments to care, and engaging trusted relationships on days 0 (day of the FIT order), 7, and 14.
After completion of study intervention, patients in aim 2 are followed up at 3 and 6 months from the date of the FIT order.
