BACKGROUND AND PURPOSE:

• Miller et al. (JAMA Intern Med, 2025) assessed whether a more intensive in-office mobile app implementation strategy results in improved colorectal cancer (CRC) screening uptake

METHODS:

• Hybrid effectiveness-implementation pragmatic trial
• Participants
  • Community-based primary care practices
• Interventions
  • “Low-touch” CRC screening tablet app implementation strategy
    • On-site training and technical support
  • “High-touch” implementation strategy
    • On-site training and technical support and
    • Close support during launch | Identification of clinic champions | Clinic coaching | Regular audit | Feedback reports
• Study design
  • Implementation strategy resulted in 2 part design
    • CheckIn app: Routine screening for depression and for patients 50 to 75 years, risk factors for CRC screening
    • CRC app: decision making video about CRC screening and allows for patients to request a CRC screening test
• Primary outcome
  • Reach: Percentage of eligible patient who completed the CRC app in the month 6 after implementation
  • Effectiveness: Percentage of screening-eligible individuals after implementation who completed a CRC test within 16 weeks of their index visit

RESULTS:

• High-touch clinics: 33,435 patients | Low-touch clinics: 16,741 patients
  • Mean age: 55.6 (SD, 17.7) | Female: 59% | Commercial insurance: 51%
  • American Indian or Alaska Native: 2.0% | Black or African American: 11.2% | Native Hawaiian: 0.1% | White: 81.1% | Other: 4.5% | Unknown: 0.3%
• CRC app use was similar in the first month of implementation
  • High-touch: 5.8% | Low-touch: 5.3% | P=0.55
• App use decreased at 6 months, but remained similar in both groups
  • High-touch: 0.9% | Low-touch: 1.0% | P=0.93
• Compared with low-touch clinics, high-touch clinics had similar use of
  • The CheckIn app: Odds ratio (OR) 2.8 (95% CI, 0.9 to 9.0)
  • The CRC app: OR 1.7 (95% CI, 1.0 to 3.0)
• After adjusting for month, there was no observed difference in CRC screening after the CRC app was implemented compared with 8 months before implementation
  • OR 0.9 (95% CI, 0.7 to 1.2)

CONCLUSION:

• The use of a patient-facing app designed to increase CRC screening adherence was low, even in clinics that participated in a more intensive implementation strategy
• The authors state

Given the challenges of staff turnover, change fatigue, and competing time demands, direct-to-patient delivery of apps outside clinical visits should be explored

Learn More – Primary Sources:

High-Touch vs Low-Touch Strategy for Implementing a CRC Screening Digital Health Intervention: A Randomized Clinical Trial