A randomized intervention to improve ongoing participation in mammography

Objective: To test the effectiveness of interventions intended to increase rates of regular breast cancer screening; according to recommended guidelin es. Study Design: A randomized controlled trial of 2 outreach interventions (a mail reminder and a telephone reminder plus appointment scheduling) compare d with a routine publicity campaign to encourage continued participation in mammography screening. Participants and Methods: Participants were 1908 women aged 50 to 75 years continuously enrolled in a large group-model HMO during the study who under went a bilateral mammogram during the first quarter of 1994 and no subseque nt mammogram during the next 18 to 21 months. Data were obtained from healt h plan administrative data files supplemented by medical chart review. Wome n were randomly assigned to receive (1) a mail reminder, (2) a telephone re minder, or (3) routine publicity on mammography for all women. The outcome measure was a mammogram received after the intervention period and within 2 years of the initial mammogram date. Results: Bivariate and multivariate statistical analyses showed that partic ipation was significantly higher for women contacted by telephone than thro ugh routine publicity. Mail reminders were no more effective than a routine publicity campaign. Primary care physician and gynecologist visits increas ed the likelihood of a subsequent mammogram for women in all intervention g roups. Conclusions: Telephone contact by regular health plan staff was more succes sful than publicity in encouraging continued participation in mammography s creening in women enrolled in a group-model managed health care plan. Becau se mailings did not influence participation in mammography screening, healt h plans should be cautious about investing in member mailings without first evaluating their effectiveness in the context of existing outreach efforts .