Format

Send to

Choose Destination
Am J Prev Med. 2010 Oct;39(4):334-44. doi: 10.1016/j.amepre.2010.05.020.

Finding the minimal intervention needed for sustained mammography adherence.

Author information

1
Division 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

Abstract

BACKGROUND:

Regular adherence to mammography screening saves lives, yet few women receive regular mammograms.

DESIGN:

RCT.

SETTING/PARTICIPANTS:

Participants were recruited through a state employee health plan. All were women aged 40-75 years and had recent mammograms prior to enrollment (n=3547). Data were collected from 2004 to 2009.

INTERVENTION:

Trial tested efficacy of a two-step adaptively-designed intervention to increase mammography adherence over 4 years. The first intervention step consisted of three reminder types: enhanced usual care reminders (EUCR); enhanced letter reminders (ELR); both delivered by mail, and automated telephone reminders (ATR). After delivery of reminders, women who became off-schedule in any of the 4 years received a second step of supplemental interventions. Three supplemental intervention arms contained priming letters and telephone counseling: barriers only (BarriCall); barriers plus positive consequences of getting mammograms (BarriConCall+); and barriers plus negative consequences of not getting mammograms (BarriConCall-).

MAIN OUTCOME MEASURES:

Average cumulative number of days non-adherent to mammography over 4 years based on annual screening guidelines (analyses conducted in 2009).

RESULTS:

All reminders performed equally well in reducing number of days of non-adherence. Women randomized to receive supplemental interventions had significantly fewer days of non-adherence compared to women who received EUCR (p=0.0003). BarrConCall+ and BarrConCall- conditions did not significantly differ in days non-adherent compared to women in the barriers-only condition (BarriCon).

CONCLUSIONS:

The minimal intervention needed for sustained mammography use is a combination of a reminder followed by a priming letter and barrier-specific telephone counseling for women who become off-schedule. Additional costs associated with supplemental interventions should be considered by organizations deciding which interventions to use.

TRIAL REGISTRATION NUMBER:

NCT01148875.

PMID:
20837284
PMCID:
PMC2939860
DOI:
10.1016/j.amepre.2010.05.020
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center