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Finding the minimal intervention needed for sustained mammography adherence.

Jennifer M Gierisch¹, Jessica T DeFrank, J Michael Bowling

¹Division of General Internal Medicine, Duke University Medical Center and Center for Health Services Research in Primary Care, Durham VAMC, Durham, North Carolina 27705, USA. j.gierisch@duke.edu

American Journal of Preventive Medicine

|September 15, 2010

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This study found that a multi-step intervention significantly increased mammography adherence. A reminder followed by tailored counseling effectively reduced non-adherence for women’s cancer screenings.

Area of Science:

Public Health
Preventive Medicine
Health Behavior Research

Background:

Regular mammography screening is crucial for early breast cancer detection and improved survival rates.
Despite proven benefits, mammography adherence remains suboptimal in many populations.
This study addresses the gap in regular mammography screening among women.

Purpose of the Study:

To evaluate the efficacy of a two-step adaptive intervention designed to enhance mammography adherence over four years.
To compare different types of reminders and supplemental interventions for improving screening compliance.

Main Methods:

A randomized controlled trial (RCT) involving 3547 women aged 40-75 years recruited from a state employee health plan.
The intervention included initial reminder strategies (enhanced usual care, enhanced letters, automated telephone reminders) followed by supplemental interventions (priming letters and telephone counseling) for non-adherent participants.

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The primary outcome measure was the average cumulative number of days non-adherent to mammography over four years.

Main Results:

All initial reminder types demonstrated equal effectiveness in reducing non-adherence.
Women receiving supplemental interventions showed significantly fewer days of non-adherence compared to the enhanced usual care group (p=0.0003).
Supplemental interventions focusing on barriers alone, or barriers with positive/negative consequences, did not significantly differ in efficacy.

Conclusions:

A combination of initial reminders, priming letters, and barrier-specific telephone counseling is effective for sustained mammography use.
Healthcare organizations should consider the costs associated with supplemental interventions when implementing adherence programs.
Targeted counseling for women who become off-schedule is key to maintaining regular mammography screening.