Background: To maximize the benefits of colorectal cancer screening, it is essential to
ensure that high-risk populations with positive initial screening results promptly
complete diagnostic follow-up colonoscopy. This study tested the effect of a nudge
intervention based on future-oriented thinking on improving adherence to colonoscopy
among high-risk populations.
Methods: A pragmatic, cluster-randomized clinical trial was conducted across six
community health centers in China, enrolling patients who had positive results from
initial colorectal cancer screenings between January 1, 2024, and September 20, 2024.
The community health centers were randomly assigned to either a nudge intervention
group based on future-oriented thinking or a usual care group. The primary outcome
was the adherence rate for colonoscopy within the year of 2024.
Results: A total of 1639 individuals with high risk of being diagnosed with colorectal
cancer, 1180 (72.0%; mean [SD] age, 63.4 [6.7] years) in the intervention group and
459 (28.0%; mean [SD] age, 63.3 [7.1] years) in the control group, belonging to three
community health centers in the intervention group and three in the control group, were
included in the study. The proportion who completed recommended follow-up
colonoscopy was 41.6% in the intervention group (n = 491) and 34.9% in the control
group (n = 160) (P  <  0.05). Participants in the nudge intervention were more likely to
attend colonoscopy compared to usual care (OR, 1.33 [95% CI, 1.04-1.70]).
Conclusion: The study find that the nudge intervention based on future-oriented
thinking improved adherence to colonoscopy among high-risk populations. Further
research is needed with larger and more balanced samples.