Increasing CRC Screening in Community Health Centers Through Mobile Messaging Optimization

The goal of this interventional study is to create and test a comprehensive and low burden text message program within existing Community Health Centers (CHC) electronic records system to encourage patients to complete at home colorectal cancer (CRC) screening and to make sure they get follow-up care if their results are abnormal. First, the investigators will learn from clinic staff and patients what their needs and preferences are in terms of use of technology. This information will be used to design the text messages program. * Clinic patients will participate in focus groups * Clinic staff will participate in interviews Second, the investigators will test a series of different message versions in two batches (experiments): * Clinic patients with orders for an at-home colorectal cancer screening kit will receive the different message versions. * In the first batch, the messages that get the most engagement from patients will be selected to be used in the second experiment. * In the second batch, the investigators will test which messages lead to the most colorectal cancer screening completion. * This will be rolled-out within the clinics existing electronic record system. The study team will not receive any information that will identify individual patients. Lastly, the investigators will check again with clinic staff to learn how the program performed, and what would be needed to continue using the text message program in the long run. -Clinic staff will participate in interviews and surveys.

Eligibility Criteria for CHC Patients Cohorts Inclusion Criteria (CHC Patients): * Adults 45-75 years old * Receive care in partner CHCs * Are of average risk for colorectal cancer * Received a stool-based testing order at their CHC * Have a mobile phone and can receive text messages (Aim 1 quantitative cohort only) * Fluent in English, Spanish, or another predominant language to be identified by the PI (applicable to patients focus groups cohort only) Exclusion Criteria (CHC Patients): * Personal or family history of CRC or colorectal polyps * History of inflammatory bowel disease * Heritable conditions that put them at above average risk for colorectal cancer (e.g., familial adenomatous polyposis) Eligibility Criteria for CHC Staff Cohorts Inclusion Criteria (CHC Staff) * Adult employees of participating CHCs * Job responsibilities include activities related to CRC screening Exclusion Criteria (CHC Staff) * None