{ "abstract": "Uptake of evidence-based interventions that prevent cancer is very low. Electronic signposting using digital messages sent via electronic healthcare systems is increasingly utilised to improve service reach and uptake. However, theory for optimising the implementation of electronic signposting to cancer prevention interventions is lacking. We sought to generate a novel programme theory to illuminate what type of electronic signposting works, for whom and in what circumstances. A realist review, informed by Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES I), was conducted. Medline, EMBASE, CINAHL, Scopus, PsycINFO, ERIC and AMED databases, and grey literature were searched. Studies that contributed information on context and mechanisms of action for electronic signposting to cancer prevention interventions for adults in any healthcare setting were included. Studies were assessed for quality based on relevance, richness and rigour. Realist synthesis and input from stakeholders, including patients, was used to aid development of our novel programme theory. Thirty studies were included, 26 of which were conducted in the United States. 57 individual context-mechanism-outcome configurations were identified. For patients, memorable messages using wording tailored to patient characteristics, and use of a popular communication channel (e.g., SMS text) improved ‘buy-in’ and usability. For providers, a good fit with organisational priorities, workflow, and establishing compatibility with existing technical systems was important. Increasing optimism of technology and ensuring electronic signposting did not risk existing patient-provider relationships were also key to success. To reduce cancer and cancer disparities, policymakers and providers need to implement electronic signposting in ways that promote ‘buy-in’, ensure perceived usability, and nurture positive attitudes towards technology. The field would benefit from further qualitative insight, health economic analysis, exploration of equity and long-term outcomes, and research in non-USA contexts. Protocol registration: PROSPERO [CRD42024586907]. Author summary: Cancer is responsible for growing health and economic problems worldwide. Effective cancer prevention interventions exist, but their uptake can be very poor. Electronic signposting uses electronic health records to identify individuals at risk and signpost these individuals to health services using digital messages, such as text messages. This could be a low-cost and effective way to increase uptake and use of cancer prevention interventions, but knowledge for how best to use electronic signposting is low. We aimed to understand what type of electronic signposting works, for whom, and in what circumstances. We found that simple memorable messages, customised to different types of patients, increased use of messages that were signposting patients to cancer prevention interventions. For health professionals, ensuring a good fit with organisational priorities and systems, increased the chances of sending messages. It was also important to maintain and build on existing patient-provider relationships. Our theory shows that electronic signposting needs design input from a range of patients and professionals to be most effective.", "abstract_shown": true, "affiliations": [ "School of Health Sciences, University of East Anglia, Norwich, England", "Primary Care and Population Health, University College London, London, England", "Leicester Diabetes Centre, The University of Leicester, Leicester, England", "Department of Public Health, West Suffolk NHS Foundation Trust, Bury St. Edmunds, England", "Norwich Medical School, University of East Anglia, Norwich, England", "Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America", "National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE), Cambridge, England" ], "article_type": "Research Article", "arxiv": null, "author_total": 10, "authors": [ { "affs": [ 0 ], "name": "Tracey J. Brown" }, { "affs": [ 1 ], "name": "Natalie An Qi Tham" }, { "affs": [ 2 ], "name": "Felix Naughton" }, { "affs": [ 3 ], "name": "Henry Goodfellow" }, { "affs": [ 4 ], "name": "Louise Hull" }, { "affs": [ 5 ], "name": "Helena Jopling" }, { "affs": [ 6 ], "name": "Helen M. Parretti" }, { "name": "Alex T. Ramsey" }, { "name": "Adam P. Wagner" }, { "name": "Zarnie Khadjesari" } ], "bibtex": "https://research.draconitic.com/paper/72kzrc0tne2z9.bib", "cited_by": 1, "doi": "10.1371/journal.pdig.0001770", "fulltext_url": "https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001770", "id": "72kzrc0tne2z9", "issns": [ "2767-3170" ], "landing_url": "https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001770", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "3600|Health Policy Implementation Science" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/Cancer detection and diagnosis/Cancer screening" ], [ "plos", "/Medicine and health sciences/Health care/Patients" ], [ "plos", "/Medicine and health sciences/Health care/Primary care" ], [ "plos", "/Medicine and health sciences/Oncology/Cancer detection and diagnosis/Cancer screening" ], [ "plos", "/Medicine and health sciences/Oncology/Cancer prevention" ], [ "plos", "/Medicine and health sciences/Oncology/Cancers and neoplasms" ], [ "plos", "/Medicine and health sciences/Oncology/Cancers and neoplasms/Colorectal cancer" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Health screening" ], [ "plos", "/Research and analysis methods/Database and informatics methods/Database searching" ] ], "openalex": "W7220368202", "pdf_url": "https://journals.plos.org/digitalhealth/article/file?id=10.1371/journal.pdig.0001770&type=printable", "pmcid": null, "pmid": null, "published": "2026-10-05", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/72kzrc0tne2z9.ris", "sources": [ { "first_seen": "2026-10-30T12:17:37Z", "native_id": "10.1371/journal.pdig.0001770", "source": "plos", "url": "https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001770" } ], "subjects": [ { "field": "medicine", "origin": "plos:oncology", "subfield": "oncology" } ], "title": "Implementation of electronic signposting to interventions that prevent cancer: A realist review", "title_text": "Implementation of electronic signposting to interventions that prevent cancer: A realist review", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:37Z", "url": "https://research.draconitic.com/paper/72kzrc0tne2z9", "venue": "PLOS Digital Health", "versions": [] }