ACTIVATING PATIENTS TO PRACTICE SKIN-CANCER PREVENTION - RESPONSE TO MAILED MATERIALS FROM PHYSICIANS VERSUS HMOS

Objectives: We investigated whether the source and emphasis of mailed messages about skin cancer would differentially activate patients to i nitiate skin cancer prevention by calling a toll-free number. Methods: We mailed a questionnaire to 981 randomly selected patients of a larg e medical group to assess their concern about and risk for skin cancer : 48 were returned undeliverable (n = 933). The booklet was accompanie d by a letter inviting patients to call a toll-free number. Patients r eceived the letter from one of three sources: (1) their physician, (2) their HMO, or (3) a fictitious junk mail organization. Patients recei ved one of three different messages emphasizing the effects of ultravi olet (UV) rays on (1) the risk of skin cancer, (2) aging and wrinkling of the skin, or (3) aging and wrinkling accompanied by a book further emphasizing these harmful effects of the sun. Results: The overall ac tivation rate was low (7%); nevertheless, the source of the preventive message significantly affected whether patients called in. Messages f rom physicians and HMOs were more activating than messages from the ju nk mail organization (odds ratio [OR] = 3.40, confidence intervals [CI ] = 1.66, 6.97), but messages from physicians were not more activating than messages from HMOs (OR = 1.56, CI = .90, 2.72). The emphasis of the message did not significantly affect call-in rates. Risk for skin cancer was positively associated with patient activation, but attitude s and beliefs about skin cancer prevention were unrelated to activatio n. Conclusions: These results should encourage HMOs and physicians to continue their preventive health outreach as one aspect of multicompon ent prevention efforts. The results also suggest that HMOs and physici ans can activate patients most at risk for skin cancer by emphasizing both risks of cancer and aging and wrinkling when they deliver a skin cancer preventive message.