WhatsApp Reminder on FIT Compliance
Condition: Colorectal Cancer; Screening Compliance; Fecal Immunochemical Test
MeSH terms: Colorectal Neoplasms
Study type: Interventional

Summary: 
      It is estimated that there are about 1.4 million patients with colorectal cancer (CRC)
      worldwide, with a rising trend in CRC incidence in many Asian Pacific countries. In Hong
      Kong, colorectal cancer ranks first in cancer incidence and second in cancer mortality based
      on data from 2014.

      Recent guidelines from USA, Europe and Asia Pacific region recommend CRC screening for
      average-risk asymptomatic individuals starting at age 50. Fecal immunochemical tests (FIT),
      is one of the recommendation as first-line modality for CRC screening. Since yearly testing
      is recommended to maintain programmatic effectiveness longitudinal adherence is a critical
      component of FOBT-based screening programs. Our previous study conducted in Hong Kong showed
      that the rate of compliance with CRC screening was declining since the first year of
      enrolment8.

      In recent years, social media (SM) has become an increasingly popular source of health
      information. By providing an easily accessible and interactive channel of communication
      between reviewers and information providers, it has potential values for affecting public
      health. However, the effects of SM on the compliance of CRC screening by FIT has not yet been
      studied.

      WhatsApp Messenger, is the most popular social media messaging app worldwide. This randomized
      controlled study will investigate the effect of WhatsApp vs no reminder on the compliance of
      CRC screening by FIT.
    

Detailed description: 
      It is estimated that there are about 1.4 million patients with colorectal cancer (CRC)
      worldwide, with a rising trend in CRC incidence in many Asian Pacific countries. In Hong
      Kong, colorectal cancer ranks first in cancer incidence and second in cancer mortality based
      on data from 2014.

      Recent guidelines from USA, Europe and Asia Pacific region recommend CRC screening for
      average-risk asymptomatic individuals starting at age 50. Fecal immunochemical tests (FIT),
      is one of the recommendation as first-line modality for CRC screening. Since yearly testing
      is recommended to maintain programmatic effectiveness longitudinal adherence is a critical
      component of FOBT-based screening programs. Our previous study conducted in Hong Kong showed
      that the rate of compliance with CRC screening was declining since the first year of
      enrolment8.

      In recent years, social media (SM) has become an increasingly popular source of health
      information. By providing an easily accessible and interactive channel of communication
      between reviewers and information providers, it has potential values for affecting public
      health. However, the effects of SM on the compliance of CRC screening by FIT has not yet been
      studied.

      WhatsApp Messenger, is the most popular social media messaging app worldwide. This randomized
      controlled study will investigate the effect of WhatsApp vs no reminder on the compliance of
      CRC screening by FIT.

      All subjects will be recruited from the existing cohort of screening participants who joined
      the bowel cancer screening programme in the CUHK JC Bowel Cancer Education Centre in 2016
      with FOBT negative in the first round of screening, and who are expected to follow-up and
      return to the centre in 2017 for their second round of FOBT screening.

      Each study subjects will be offered either an interactive WhatsApp reminder to return to the
      centre for taking faecal tubes for screening; or usual care, where no additional intervention
      will be offered. A simple random sampling process will be administered using
      computer-generated numbers so that each participant will have a 50% probability for
      assignment into each group. All potential participants identified who are eligible for the
      study will be randomized by a computer randomizer, which will give a number indicating the
      group assigned.

      The outcome of interest included the proportion of subjects who return to the centre and
      retrieve faecal tubes for screening 30 days within the scheduled time for the second year of
      the screening test.

      To investigate the long-term effect of WhatsApp reminder on FIT compliance, all subjects in
      this study (except those died or had positive FIT result) will be called in the first quarter
      of 2019 and offered FIT again in a cross-over design in 2019, i.e. 1) patients initially
      randomized to WhatsApp reminder group in 2017 will receive no reminder in 2019; and 2) those
      randomized to no reminder group in 2017 will receive WhatsApp reminder in 2019.. The FIT
      pickup and return rate and reason of default will be recorded again.
    

Intervention name(s): WhatsApp reminder
Intervention type(s): Other
Intervention description(s): An interactive WhatsApp reminder to return to the centre for taking faecal tubes for screening
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Screening