Can tailored interventions increase mammography use among HMO women?

Background: Telephone counseling and tailored print communications have eme rged as promising methods for promoting mammography screening. However, the re has been little research testing, within the same randomized field trial , of the efficacy of these two methods compared to a high-quality usual car e system for enhancing screening. This study addressed the question: Compar ed to usual care, is tailored telephone counseling more effective than tail ored print materials for promoting mammography screening! Design: Three-year randomized field trial. Participants: One thousand ninety-nine women aged 50 and older recruited fr om a health maintenance organization in North Carolina. Intervention: Women were randomized to 1 of 3 groups: (1) usual care, (2) t ailored print communications, and (3) tailored telephone counseling. Main Outcome: Adherence to mammography screening based on self-reports obta ined during 1995, 1996, and 1997. Results: Compared to usual care alone, telephone counseling promoted a sign ificantly higher proportion of women having mammograms on schedule (71% vs 61%) than did tailored print (67% vs 61%) but only after the first year of intervention (during 1996). Furthermore, compared to usual care, telephone counseling was more effective than tailored print materials at promoting be ing on schedule with screening during 1996 and 1997 among women who were of f-schedule during the previous year. Conclusions: The effects of the intervention were most pronounced after the first intervention. Compared to usual care, telephone counseling seemed pa rticularly effective at promoting change among nonadherent women, the group for whom the intervention was developed. These results suggest that teleph one counseling rather than tailored print, might be the preferred first-lin e intervention for getting nonadherent women on schedule for mammography sc reening. Many questions would have to be answered about why the tailored pr int intervention was not more powerful. Nevertheless, it is clear that addi tional interventions will be needed to maintain women's adherence to mammog raphy.