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Reminder letter, tailored stepped-care, and self-choice comparison for repeat mammography
William Rakowski1, Isaac M Lipkus, Melissa A Clark
1Department of Community Health, Box G-A4, Brown University, Providence, Rhode Island 02912, USA. william_rakowski@brown.edu
Background:
The main benefits of mammography come from regular on-schedule screening. However, few studies have examined interventions to achieve repeat screening.
Setting And Participants:
Participants were women aged 50 to 74, recruited through one setting in Rhode Island and another in North Carolina. Participants had a mammogram already scheduled at recruitment, and had to keep that appointment in order to be eligible for the repeat mammography intervention. A total of 1614 women were in the intervention sample.
Design:
A four-group randomized design was used: Group 1, a simple reminder letter; Group 2, a 2-month, tailored, stepped intervention delivered 2 months after the completed mammogram; Group 3, a 10-month, tailored, stepped intervention delivered 2 months before the repeat mammogram was due; and Group 4, self-choice of one of the above three strategies.
Intervention:
The intervention took place between June 1996 and May 1997. The reminder letter and two levels of the stepped intervention were delivered by mail. The third level of the stepped strategy was a counselor telephone call. Groups 2 and 3 were identical, except for timing.
Outcome Measure:
Obtaining the next due mammogram within 15 months, based on clinic records.
Results:
There were no statistically significant differences among the four groups, both in the total sample and at the two sites separately.
Conclusions:
On average, a simple reminder may be as effective as more complex strategies for women with a prior on-schedule exam. However, attention is still needed to identify women at risk of lapsing from screening. Some women may require more-intensive interventions.