Developing and testing automated Interactive reminders for cervical cancer screening and chronic disease follow-up in Brazilian primary care
1
Product development - Messaging, ImpulsoGov, São Paulo, Brazil
2
Universidade Federal do ABC, São Paulo, Brazil
3
Monitoring and Evaluation, ImpulsoGov, São Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A910
ABSTRACT
BACKGROUND:
Gaps in preventive care remain a challenge in Brazil’s Unified Health System¹². We developed automated WhatsApp reminders and evaluated them through a process that combined qualitative research, pilot testing, and a randomized controlled trial.
METHODS:
The intervention was developed in two phases. Phase 1 consisted of a pilot study including semi-structured interviews with primary care users guided by the COM-B model (Behavior Change Framework)³, followed by implementation and quantitative assessment in 4 municipalities, alongside qualitative interviews with Primary Health Care (PHC) professionals. Phase 2 was a cluster-randomized controlled trial conducted in 12 municipalities. Reminders were sent to women aged 25–64 years overdue for cervical cancer screening and to adults with hypertension and/or diabetes overdue for follow-up. Outcomes were measured using electronic PHC records.
RESULTS:
In the pilot phase, completion of cervical cancer screening increased from 1.3% in the control group to 2.6% (OR: 2.14 [95% CI: 1.23-3.70]) with reminders that included scheduling, and 3.1% (OR 2.52 [1.47-4.32]) with reminders without scheduling. No relevant differences were observed for chronic disease follow-up. PHC professionals reported high satisfaction with the intervention and perceived workflow benefits. In the randomized trial, reminders non-significantly increased cervical cancer screening (OR: 1.25 [0.63-2.48]) and chronic care follow-up (OR: 1.24 [0.81, 1.90]). Positive framing improved cervical screening completion, whereas messages including video reduced uptake. Qualitative findings highlighted barriers such as fear of scams, low literacy, and frequent changes in phone numbers.
CONCLUSIONS:
Automated message reminders are feasible to implement within PHC systems, but their effectiveness is constrained by data quality and contextual barriers. Iterative testing informed product development and highlighted the need for institutional endorsement, accessible message formats, and continuous updating of contact information to enhance reach and impact.
Gaps in preventive care remain a challenge in Brazil’s Unified Health System¹². We developed automated WhatsApp reminders and evaluated them through a process that combined qualitative research, pilot testing, and a randomized controlled trial.
METHODS:
The intervention was developed in two phases. Phase 1 consisted of a pilot study including semi-structured interviews with primary care users guided by the COM-B model (Behavior Change Framework)³, followed by implementation and quantitative assessment in 4 municipalities, alongside qualitative interviews with Primary Health Care (PHC) professionals. Phase 2 was a cluster-randomized controlled trial conducted in 12 municipalities. Reminders were sent to women aged 25–64 years overdue for cervical cancer screening and to adults with hypertension and/or diabetes overdue for follow-up. Outcomes were measured using electronic PHC records.
RESULTS:
In the pilot phase, completion of cervical cancer screening increased from 1.3% in the control group to 2.6% (OR: 2.14 [95% CI: 1.23-3.70]) with reminders that included scheduling, and 3.1% (OR 2.52 [1.47-4.32]) with reminders without scheduling. No relevant differences were observed for chronic disease follow-up. PHC professionals reported high satisfaction with the intervention and perceived workflow benefits. In the randomized trial, reminders non-significantly increased cervical cancer screening (OR: 1.25 [0.63-2.48]) and chronic care follow-up (OR: 1.24 [0.81, 1.90]). Positive framing improved cervical screening completion, whereas messages including video reduced uptake. Qualitative findings highlighted barriers such as fear of scams, low literacy, and frequent changes in phone numbers.
CONCLUSIONS:
Automated message reminders are feasible to implement within PHC systems, but their effectiveness is constrained by data quality and contextual barriers. Iterative testing informed product development and highlighted the need for institutional endorsement, accessible message formats, and continuous updating of contact information to enhance reach and impact.
| eISSN: | 2654-1459 |
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