Using physician correspondence and postcard reminders to promote mammography use

In a health maintenance organization that mails letters to women recommending that they schedule mammograms, we conducted a randomized trial to evaluate simple methods of increasing the use of screening mammography.

Using a 2 x 2 factorial design, we tested the effects of (1) mailing the recommendation letter from each woman's primary care physician rather than from the program director and (2) sending a subsequent reminder postcard.

Sending a reminder postcard nearly doubled the odds that women would get mammograms within 1 year (participate). The letter from the woman's personal physician had no effect. Attending a clinic more than 45 minutes from the screening center, being a current smoker, or being in fair or poor health were negatively associated with subsequently obtaining a mammogram. The odds of participation doubled if women had had previous mammograms.

When preceded by written recommendations to schedule mammograms, reminder postcards effectively increased participation. Future randomized trials to promote use of screening mammography should compare interventions with a reminder condition.