Effectiveness of Using Mobile Health Technology in Colorectal Cancer Screening Uptake

NCT06192862 | Completed

• 1 other identifier: 2022.614
• Study Type: interventional
• Target: 500
• Locations: 1 country
• Sites: 1

Brief Summary

In Hong Kong, colorectal cancer (CRC) ranked second in both cancer incidence and mortality. The fecal immunochemical test (FIT) helps reduce the incidence and mortality of CRC and is widely used for population-based CRC screening. The government-subsidized CRC screening program was launched in Hong Kong as a pilot in 2015 and fully implemented in 2020. The program was subsidized for asymptomatic Hong Kong residents, aged 50-75 years, to receive FIT screening every two years. A subsidized follow-up colonoscopy was offered for a positive FIT result. For a negative FIT result, the participant was advised to repeat the screening two years later. Despite the subsidy and promotion, the uptake rate of the population-based colorectal cancer screening was low. Only 275,000 (\~10%) underwent FIT screening under this program as of 31st December 2021. Similar to colonoscopy screening outreach, FIT screening can be done by providing contact information with primary care physicians located in the subject's preferred district via mobile messenger-based chatbots to arrange it. Chatbots have already proven to be useful in increasing the intention to vaccinate against COVID-19. Moreover, CRC screening uptake is highly associated with Health Belief Model (HBM) constructs and high risk perception of developing CRC is associated with higher screening uptake rate. HBM-based education and Trans-Theoretical Model (TTM)-based personalized risk assessment of CRC may increase the screening uptake rate by improving their knowledge of CRC screening (in terms of susceptivity, perceived benefits, and cues to actions) and informing subjects that they are at a relatively higher risk of developing CRC. Therefore, we will develop a theory-based mobile messenger-initiated chatbot and conduct a randomized controlled trial to evaluate its performance in improving the CRC screening uptake when compared to standard text reminders.

Conditions

Colorectal Cancer

Keywords

colorectal cancer; screening; fecal immunochemical test

Outcome Measures

Primary Outcomes (1)

• CRC screening uptake rate at 3 months

  The primary outcome is the CRC screening uptake rate, defined as participation in and completion of the government-subsidized CRC screening program by returning valid FIT kits at three months after intervention

  during the study period up to three months

Secondary Outcomes (4)

• CRC screening uptake rate at 6 months

  during the study period up to six months

• time interval

  during the study period up to six months

• qualitative factors checklist associated with CRC screening

  during the study period up to six months

• Likert scale

  during the study period up to six months

Study Arms (2)

Text reminder group (control)

NO INTERVENTION

Randomized subjects to the text reminder group will be asked about their intention to undergo CRC screening in the next 6 months. For those who are at pre-contemplation and contemplation stage, a standard text message will be delivered to invite them to undergo CRC screening by informing them that they are due to CRC screening because they are aged \>50 years and are yet to receive CRC screening. No HBM-based health education video or personalized risk assessment will be provided. The chatbot then asks the subject's intention to undergo CRC screening again. For those who propelled to preparation stage or those who are at preparation stage at the beginning, the website link of the government-subsidized CRC screening program which lists the names of all primary care physicians and their contact and co-payment information will be provided.

Chatbot outreach group

EXPERIMENTAL

Subjects in chatbot outreach group will be asked about their intention to undergo CRC screening in the next 6 months and their TTM stage will be determined according to their answers. For subjects who are at preparation stage, the chatbot will further request for the preferred district to have a consultation under the government-subsidized CRC screening. For subjects who are at pre-contemplation stage, the chatbot will deliver an HBM-based health education video filmed by gastroenterologists and colorectal cancer survivor who has been diagnosed by screening. The subject's intention will be asked again after the video. For those who upgrade to contemplation stage or remain at pre-contemplation stage and those who are at contemplation stage at the beginning, the chatbot will assess the personalized risk of CRC using the Asia-Pacific Colorectal Screening Score (APCS). Finally, the subject's intention to undergo screening will be asked for the last time.

Behavioral: Assessment of screening intention and Transtheoretical Model stages for CRC screening

Interventions

Assessment of screening intention and Transtheoretical Model stages for CRC screening BEHAVIORAL

Screening Intentions will be measured by asking the subject, ""How much do you agree or disagree: I am intending to have colon cancer screening within the next 6 months". Subjects who "strongly disagrees" or "somewhat disagrees" are considered not having screening intention. Subjects who "somewhat agrees" or "strongly agrees" are considered having screening intention. For subjects who has screening intention, they will be asked if they have plan to arrange a consultation with primary care physician to collect FIT kits in next 3 months.

Chatbot outreach group

Eligibility Criteria

• Age: 50 Years - 75 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• years old
• asymptomatic and eligible to enroll in a government-subsidized colorectal cancer screening program
• subjects themselves or their family members living in the same household with access to WhatsApp Messenger
• able to read Chinese
• willingness to be followed up by telephone

You may not qualify if:

• subject without access to WhatsApp Messenger
• unable to provide informed consent

Sponsors & Collaborators

• Chinese University of Hong Kong: lead

Study Sites (1)

Centre of Digestive Health, Prince of Wales Hospital

Hong Kong, Hong Kong

Location

Related Publications (1)

• Hu Y, Lau WM, Wang ZJ, Tang RSY, Wu X, Mo PKH, Wong SYS, Meng MLH, Dong D, Sung JJY, Lam TYT. Theory-based chatbot for promoting colorectal cancer screening in a community setting in Hong Kong: study protocol of a randomised controlled trial. BMJ Open. 2025 Jul 10;15(7):e103857. doi: 10.1136/bmjopen-2025-103857.

  PMID: 40639841 DERIVED

MeSH Terms

Conditions

Colorectal Neoplasms

Condition Hierarchy (Ancestors)

Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Rectal Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: There will no masking
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant professor

Model Details: Patient will be randomized into either Text reminder (control) group or Chatbot outreach group

Study Record Dates

• First Submitted: December 11, 2023
• First Posted: January 5, 2024
• Study Start: July 1, 2024
• Primary Completion: January 31, 2025
• Study Completion: November 30, 2025
• Last Updated: June 3, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

HK (1)