Activating patients to practice skin cancer prevention: response to mailed materials from physicians versus HMOs

We investigated whether the source and emphasis of mailed messages about skin cancer would differentially activate patients to initiate skin cancer prevention by calling a toll-free number.

We mailed a questionnaire to 981 randomly selected patients of a large medical group to assess their concern about and risk for skin cancer: 48 were returned undeliverable (n = 933). The booklet was accompanied by a letter inviting patients to call a toll-free number. Patients received the letter from one of three sources: (1) their physician, (2) their HMO, or (3) a fictitious junk mail organization. Patients received one of three different messages emphasizing the effects of ultraviolet (UV) rays on (1) the risk of skin cancer, (2) aging and wrinkling of the skin, or (3) aging and wrinkling accompanied by a book further emphasizing these harmful effects of the sun.

The overall activation rate was low (7%); nevertheless, the source of the preventive message significantly affected whether patients called in. Messages from physicians and HMOs were more activating than messages from the junk mail organization (odds ratio [OR] = 3.40, confidence intervals [CI] = 1.66, 6.97), but messages from physicians were not more activating than messages from HMOs (OR = 1.56, CI = .90, 2.72). The emphasis of the message did not significantly affect call-in rates. Risk for skin cancer was positively associated with patient activation, but attitudes and beliefs about skin cancer prevention were unrelated to activation.

These results should encourage HMOs and physicians to continue their preventive health outreach as one aspect of multicomponent prevention efforts. The results also suggest that HMOs and physicians can activate patients most at risk for skin cancer by emphasizing both risks of cancer and aging and wrinkling when they deliver a skin cancer preventive message.