Testing e-mail content to encourage physicians to access an audit and feedback tool: a factorial randomized...

Area of Science:

• Health Services Research
• Behavioral Science
• Public Health

Background:

• An online audit and feedback tool for cancer screening in Ontario is underutilized by primary care physicians.
• The tool provides physicians with patient data for overdue cancer screenings.

Purpose of the Study:

• To investigate the impact of behavior change techniques in email messages on physician access to an audit and feedback tool.
• To determine the effect of these messages on cancer screening rates.

Main Methods:

• A pragmatic 2x2x2 factorial experiment involving 5449 primary care physicians.
• Tested three behavior change techniques: anticipated regret, material incentive, and problem-solving.
• Assessed outcomes using administrative data and conducted a qualitative process evaluation.

Main Results:

• Fewer than half of physicians opened the emails, and less than 10% clicked through.
• Problem-solving messages reduced tool access (RR: 0.871) but increased cervical cancer screening (RR: 1.003).
• This increase could represent 7568 additional screenings; no other significant effects were found.

Conclusions:

• Physician engagement with audit and feedback tools is crucial for their effectiveness.
• Email message content modifications can influence clinical behavior.
• Future strategies should prioritize user-centered design for cancer screening tools.