Implementation of electronic signposting to interventions that prevent cancer: A realist review
7 affiliations
- 1School of Health Sciences, University of East Anglia, Norwich, England
- 2Primary Care and Population Health, University College London, London, England
- 3Leicester Diabetes Centre, The University of Leicester, Leicester, England
- 4Department of Public Health, West Suffolk NHS Foundation Trust, Bury St. Edmunds, England
- 5Norwich Medical School, University of East Anglia, Norwich, England
- 6Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
- 7National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE), Cambridge, England
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.
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BibTeX
@article{brown2026implementation,
title = {{Implementation of electronic signposting to interventions that prevent cancer: A realist review}},
author = {Tracey J. Brown and Natalie An Qi Tham and Felix Naughton and Henry Goodfellow and Louise Hull and Helena Jopling and Helen M. Parretti and Alex T. Ramsey and Adam P. Wagner and Zarnie Khadjesari},
journal = {PLOS Digital Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pdig.0001770},
url = {https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001770},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Implementation of electronic signposting to interventions that prevent cancer: A realist review
AU - Tracey J. Brown
AU - Natalie An Qi Tham
AU - Felix Naughton
AU - Henry Goodfellow
AU - Louise Hull
AU - Helena Jopling
AU - Helen M. Parretti
AU - Alex T. Ramsey
AU - Adam P. Wagner
AU - Zarnie Khadjesari
PY - 2026
DA - 2026/10/05
JO - PLOS Digital Health
DO - 10.1371/journal.pdig.0001770
UR - https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001770
AB - 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.
SN - 2767-3170
ER -