Impact of Mailed and Automated Telephone Reminders on Receipt of Repeat Mammograms: A Randomized Controlled Trial
published online 13 April 2009.
Background
This study compares the efficacy of three types of reminders in promoting annual repeat mammography screening.
Design
RCT.
Setting and participants
Study recruitment occurred in 2004–2005. Participants were recruited through the North Carolina State Health Plan for Teachers and State Employees. All were aged 40–75 years and had a screening mammogram prior to study enrollment. A total of 3547 women completed baseline telephone interviews.
Intervention
Prior to study recruitment, women were assigned randomly to one of three reminder groups: (1) printed enhanced usual care reminders (EUCRs); (2) automated telephone reminders (ATRs) identical in content to EUCRs; or (3) enhanced letter reminders that included additional information guided by behavioral theory. Interventions were delivered 2–3 months prior to women's mammography due dates.
Main outcome measures
Repeat mammography adherence, defined as having a mammogram no sooner than 10 months and no later than 14 months after the enrollment mammogram.
Results
Each intervention produced adherence proportions that ranged from 72% to 76%. Post-intervention adherence rates increased by an absolute 17.8% from baseline. Women assigned to ATRs were significantly more likely to have had mammograms than women assigned to EUCRs (p=0.014). Comparisons of reminder efficacy did not vary across key subgroups.
Conclusions
Although all reminders were effective in promoting repeat mammography adherence, ATRs were the most effective and lowest in cost. Health organizations should consider using ATRs to maximize proportions of members who receive mammograms at annual intervals.
aGillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
bDepartment of Health Behavior and Health Education, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
cDepartment of General Internal Medicine, Duke University Medical Center, Durham, North Carolina
eDepartment of Clinical Sciences, University of Texas, Southwestern Medical Center, Dallas, Texas
Address correspondence and reprint requests to: Jessica T. DeFrank, MPH, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior and Health Education, Campus Box #7440, Chapel Hill NC 27599
ABSTRACT