TY - JOUR
T1 - Finding the minimal intervention needed for sustained mammography adherence
AU - Gierisch, Jennifer M.
AU - Defrank, Jessica T.
AU - Bowling, J. Michael
AU - Rimer, Barbara K.
AU - Matuszewski, Jeanine M.
AU - Farrell, David
AU - Skinner, Celette Sugg
N1 - Funding Information:
PRISM was funded by the National Cancer Institute (grant 5R01CA105786 ). At the time of these analyses, JMG was funded by the Agency for Healthcare Research and Quality (grant 2T32HS000079 ) and JTD was funded by the UNC Cancer Care and Quality Training Program ( R25T CA116339 ).
PY - 2010/10
Y1 - 2010/10
N2 - 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 4075 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
AB - 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 4075 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
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U2 - 10.1016/j.amepre.2010.05.020
DO - 10.1016/j.amepre.2010.05.020
M3 - Article
C2 - 20837284
AN - SCOPUS:77956592629
SN - 0749-3797
VL - 39
SP - 334
EP - 344
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
IS - 4
ER -