title: Crafting Appealing Text Messages to Encourage Colorectal Cancer Screening Test Completion: A Qualitative Study.
abstract: BACKGROUND
  mHealth interventions that incorporate text messages have great potential to increase receipt of preventive health services such as colorectal cancer screening. However, little is known about older adult perspectives regarding the receipt of text messages from their health care providers.
  
  
  OBJECTIVE
  To assess whether older adults would value and access text messages from their physician's practice regarding colorectal cancer screening.
  
  
  METHODS
  We conducted four focus groups with 26 adults, aged 50 to 75 years, who had either recently completed or were overdue for colorectal cancer screening. A trained moderator followed a semistructured interview guide covering participant knowledge and attitudes regarding colorectal cancer screening, potential barriers to colorectal cancer screening, attitudes about receiving electronic communications from a doctor's office, and reactions to sample text messages.
  
  
  RESULTS
  Participant responses to three primary research questions were examined: (1) facilitators and barriers to colorectal cancer screening, (2) attitudes toward receiving text messages from providers, and (3) characteristics of appealing text messages. Two themes related to facilitators of colorectal cancer screening were perceived benefits/need and family experiences and encouragement. Themes related to barriers included unpleasantness, discomfort, knowledge gaps, fear of complications, and system factors. Four themes emerged regarding receipt of text messages from health care providers: (1) comfort and familiarity with technology, (2) privacy concerns/potential for errors, (3) impact on patient-provider relationship, and (4) perceived helpfulness. Many participants expressed initial reluctance to receiving text messages but responded favorably when shown sample messages. Participants preferred messages that contained content that was important to them and were positive and reassuring, personalized, and friendly to novice texters (eg, avoided the use of texting shorthand phrases and complicated replies); they did not want messages that contain bad news or test results. They wanted the ability to choose alternative options such as email or phone calls.
  
  
  CONCLUSIONS
  Older adults are receptive to receiving cancer screening text messages from health care providers. Sharing sample messages with patients may increase acceptance of this tool in the clinic setting. Supportive tailored text messaging reminders could enhance uptake of colorectal cancer screening by enhancing patient self-efficacy and providing cues to action to complete colonoscopy or fecal occult blood testing.
authors.affiliation: Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, NC, United States. keweaver@wakehealth.edu.
authors.forename: Kathryn E
authors.identifier: http://orcid.org/0000-0001-9006-4064
authors.initials: KE
authors.lastname: Weaver
authors.forename: Shellie D
authors.identifier: http://orcid.org/0000-0002-3599-0804
authors.initials: SD
authors.lastname: Ellis
authors.forename: Nancy
authors.identifier: http://orcid.org/0000-0002-8498-0792
authors.initials: N
authors.lastname: Denizard-Thompson
authors.forename: Donna
authors.identifier: http://orcid.org/0000-0001-6737-9818
authors.initials: D
authors.lastname: Kronner
authors.forename: David P
authors.identifier: http://orcid.org/0000-0001-7879-4427
authors.initials: DP
authors.lastname: Miller
keywords: colorectal cancer; mhealth; older adults; qualitative; screening; text messages