Time to Cancer Screening Completion Following an SMS Reminder Intervention in a Large Federally Qualified Health Center Network: Secondary Data Analysis.

Background: Delays in completing cancer screening diminish the preventive benefits of early detection, particularly among women receiving care in Federally Qualified Health Centers (FQHCs). Although many patients receive SMS reminders and complete screening, less is known about how quickly they complete testing or which patient-level and structural factors are associated with delays. Objective: This study examined factors associated with time to cancer screening completion among women aged 50 years or older who received SMS reminders and completed screening across a large FQHC network in Texas. The study also compared time to completion across three cancer screening tests: human papillomavirus (HPV) or the Papanicolaou test (hereinafter "Pap test"), mammography, and the fecal immunochemical test (FIT) or Cologuard screening. Methods: We conducted a secondary data analysis using electronic health record (EHR) data from a 56-clinic FQHC network in Texas. The initial cohort included 1803 women aged 50 years or older who (1) were overdue for HPV or Pap testing, mammography, or FIT or Cologuard screening, and (2) received at least three SMS reminders. Of those, 551 completed the screening and constituted the analytic cohort for this study. The outcome was the number of days from the initial SMS reminder to documented completion of the overdue screening test in the EHR. Kaplan-Meier methods were used to estimate time to completion by screening modality. A multivariable Cox proportional hazards model assessed associations of screening modality, sociodemographic, and clinical characteristics, and self-reported health-related social needs with the rate of screening completion. Results: Overall, 40.8% (n=212) of patients overdue for HPV or Pap testing completed their screening, while 21.1% (n=138) of those overdue for mammography and 32.1% (n=201) of those overdue for FIT or Cologuard screening completed their respective screening. Median time to completion was 72.5 (95% CI 64-86) days for HPV or Pap screening and 52.0 days for both mammography (95% CI 43-64) and FIT or Cologuard screening (95% CI 52-53). In the adjusted model, screening completion was faster for FIT or Cologuard screening (hazard ratio [HR] 1.65, 95% CI 1.34-2.05) and mammography (HR 1.41, 95% CI 1.11-1.78) than for HPV or Pap screening. Patient-reported transportation limitation was associated with slower screening completion (HR 0.74, 95% CI 0.55-0.99). Conclusions: These findings demonstrate meaningful variation in both the completion and timeliness of overdue cancer screening across screening modalities. Although HPV or Pap testing had the highest overall completion rate, time to completion was significantly shorter for mammography and FIT or Cologuard screening. The association between transportation limitations and delayed screening further underscores the influence of access-related barriers on timely preventive care. This suggests that efforts to improve cancer screening should extend beyond patient outreach to incorporate modality-specific strategies and interventions that address structural barriers to screening completion.