Testing reminder and motivational telephone calls to increase screening mammography: a randomized study

Background: Prospective randomized trials have demonstrated that motivation al telephone calls increase adherence to screening mammography. To better u nderstand the effects of motivational calls and to maximize adherence, we c onducted a randomized trial among women aged 50-79 years. Methods: We creat ed a stratified random sample of 5062 women due for mammograms within the G roup Health Cooperative of Puget Sound, including 4099 women with prior mam mography and 963 without it. We recruited and surveyed 3743 (74%) of the wo men before mailing a recommendation. After 2 months, 1765 (47%) of the 3743 women had not scheduled a mammogram and were randomly assigned to one of t hree intervention groups: a reminder postcard group (n = 590), a reminder t elephone call group (n = 585), and a motivational telephone call addressing barriers group (n = 590). The telephone callers could schedule mammography . We used Cox proportional hazards models to estimate the hazard ratio (HR) and 95% confidence interval (CI) for documented mammography use by 1 year. Results: Women who received reminder calls were more likely to get mammogr ams (HR = 1.9; 95% CI = 1.6-2.4) than women who were mailed postcards. The motivational and reminder calls (average length, 8.5 and 3.1 minutes, respe ctively) had equivalent-effects (HR = 0.97; 95% CI = 0.8-1.2), After we con trolled for the intervention effect, women with prior mammography (n = 1277 ) were much more likely to get a mammogram (HR = 3.4; 95% CI = 2.7-4.3) tha n women without prior use (n = 488), Higher income, but not race or more ed ucation, was associated with higher adherence, Conclusions: Reminding women to schedule an appointment was as efficacious as addressing barriers. Simp le intervention groups should be included as comparison groups in randomize d trials so that we better understand more complex intervention effects.