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Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Digital screening may divert lower-risk persons to lower-cost online screening, or offer higher-risk non-responders a more acceptable alternative. Population-based uptake estimates are lacking. We conducted four studies within four weeks by inviting 1700 Londoners (40\u201374 years, without cardiovascular disease) to a digital Health Check. A six-arm pragmatic unregistered randomised controlled trial (RCT) tested different Short Message Service (SMS) invitations. Uptake varied from 12% (standard SMS) to 20% (shortest SMS, <jats:italic>P<\/jats:italic>\u2009=\u20090.009). We tested three sequential reminders (an SMS, a second pragmatic trial [SMS vs postal reminder], and a final SMS). The first SMS reminder increased uptake by +3%. The postal reminder (+7%) was twice as effective as the SMS reminder (+3%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). The \u201cfinal reminder\u201d SMS added +7%. Altogether, shorter invites, multi-modal reminders, and a \u201cfinal reminder\u201d all increased uptake. Adding digital care to in person care may raise uptake from 50 to 60%. Agile evaluations can rapidly improve invitation systems.<\/jats:p>","DOI":"10.1038\/s41746-025-01672-5","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T05:22:14Z","timestamp":1748236934000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Agile evaluation including two pragmatic trials on the uptake of a digital screening service"],"prefix":"10.1038","volume":"8","author":[{"given":"Taavi","family":"Tillmann","sequence":"first","affiliation":[]},{"given":"Andrew","family":"Copas","sequence":"additional","affiliation":[]},{"given":"Paul","family":"Stokes","sequence":"additional","affiliation":[]},{"given":"Nick","family":"Udell","sequence":"additional","affiliation":[]},{"given":"Jo","family":"Stead","sequence":"additional","affiliation":[]},{"given":"Jin","family":"Lim","sequence":"additional","affiliation":[]},{"given":"Gene","family":"Libow","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"1672_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-018-6155-5","volume":"18","author":"MM Gianino","year":"2018","unstructured":"Gianino, M. 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Specifically, authors T.T. (2017\u20132020), P.S. (2001\u20132023), J.S. (2019\u20132022) and J.L. (2019\u2013present) have been employees of Southwark Council. Author G.L. received consultancy fees from Southwark Council for leading the design, development and implementation of the service reported in this paper. Author N.U. was employed by QMS Ltd. as a software developer, which was contracted by Southwark Council. Author A.C. declares no financial or non-financial competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"310"}}