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Introduction Text Message reminders and patients navigation (PN) have emerged as effective strategies to improve bowel cancer screening participation. Text message reminders offer a low-cost, scalable, approach to prompting individuals to complete screening, while patient navigation provides personalized support to help patients overcome practical, informational, and psychological barriers to screening. However, despite evidence supporting each intervention individually, direct comparisons of their impact on screening uptake remain limited.Methods We undertook a three-arm randomised controlled trial among individuals who had not completed bowel cancer screening within 18 weeks of the initial invitation. Participants were randomly assigned to one of three groups: usual care; repeated text message reminders delivered at 19, 21, 23 and 25 weeks; or a combined intervention consisting of a text message reminder at 19 weeks followed by telephone-based patient navigation at 21, 23 and 25 weeks. The primary outcome was screening participation within 26 weeks of invitation. Group differences in participation were evaluated using logistic regression analysis.Results In the intention-to-treat analysis (n=3,129) screening uptake was significantly higher in both the text message reminder and patient navigation groups compared with usual care (2.0% vs 6.5%, p < 0.001; and 2.0% vs 7.5%, p < 0.001, respectively). No statistically significant difference in uptake was observed between the text message reminder and patient navigation groups.In the per-protocol analysis (n= 2,294), screening uptake was significantly higher in both the text message reminder and patient navigation groups compared with usual care (2.0% vs 8.6%, p < 0.001; and 2.0% vs 12.6%, p < 0.001, respectively). Moreover, uptake was significantly greater in the patient navigation group than in the text message reminder group (12.6% vs 8.6%, p < 0.025).Conclusions Findings from the per-protocol analysis suggests that patient navigation is more effective than the text message reminders.