Evaluation of Mailers Promoting Mammogram Screening

Evaluation of Postcard Mailers Enhanced With Behavioral Nudges to Promote Mammogram Screening

In this evaluation, 3 different versions of mailers promoting annual mammograms are being sent to women on the month of their 50th and 64th birthdays. The researchers hypothesize that the use of behavioral nudges in the mailers should lead to increased uptake in mammogram screening.

Study Overview

• Status: Completed
• Conditions: Breast Cancer
• Intervention / Treatment: Behavioral: Postcard; Behavioral: Small Gift; Behavioral: Loss Frame and Fear Appeals

Detailed Description

Mammogram screening for women, starting at age 50, can significantly reduce the risk of complications due to breast cancer. As part of an existing outreach campaign, the health system mails a postcard and small gift (pink socks) to women on the month of their 50th and 64th birthdays to promote annual mammogram screening.

The researchers are evaluating two new versions of the mailers against a standard mailer to see which version leads to greater uptake in mammograms. The new mailers have content that applies behavioral nudge theory - specifically, loss frames and fear appeals - to encourage taking action. One of the two new versions does not include the small gift, to test whether its inclusion or exclusion has any effect on mammogram screening.

• Study Type: Interventional
• Enrollment (Actual): 1342
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Danville, Pennsylvania, United States, 17822
      • Geisinger

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years to 64 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Female Geisinger Health Plan members turning 50 and 64 in that month
• For the 2020 campaign, birthdays from June 2020 (as opposed to August 2020) will be included due to a temporary suspension of the outreach program due to the COVID-19 pandemic since June
• For the pre-post examination of the 2019 campaign, all months in that year will be included

Exclusion Criteria:

- Members who are on the do not contact list at Geisinger Health Plan

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Standard Mailer and Small Gift; A postcard encourages mammograms and includes a small gift.	Behavioral: Postcard; The postcard includes appeals to get annual mammograms and provides information for ordering a mammogram.; Behavioral: Small Gift; Pink socks are included in the mailer. The gift increases salience of the mailer and it potentially promotes reciprocation from the recipient in the form of ordering a mammogram.
Experimental: Mailer with Loss Frame, Risks, and Small Gift; The postcard is enhanced with language that further emphasizes the risks but also clearly describes how early detection with a test can reduce those risks; a small gift is included.	Behavioral: Postcard; The postcard includes appeals to get annual mammograms and provides information for ordering a mammogram.; Behavioral: Small Gift; Pink socks are included in the mailer. The gift increases salience of the mailer and it potentially promotes reciprocation from the recipient in the form of ordering a mammogram.; Behavioral: Loss Frame and Fear Appeals; The postcard is enhanced with language that frames the situation in terms of losses. It also uses fear appeals by stating the risks of breast cancer, while also stating that a mammogram screening is an accessible way to address those risks.
Experimental: Mailer with Loss Frame, Risks, and No Gift; The postcard is enhanced with language that further emphasizes the risks but also clearly describes how early detection with a test can reduce those risks; the small gift is not included.	Behavioral: Postcard; The postcard includes appeals to get annual mammograms and provides information for ordering a mammogram.; Behavioral: Loss Frame and Fear Appeals; The postcard is enhanced with language that frames the situation in terms of losses. It also uses fear appeals by stating the risks of breast cancer, while also stating that a mammogram screening is an accessible way to address those risks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mammogram Completion at 6 months (2020)	Binary variable indicating whether a mammogram was completed	6 months from intervention start date

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mammogram Completion at 12 months (2020)	Binary variable indicating whether a mammogram was completed (a longer time frame allows for late responses)	12 months from intervention start date
Primary Care Provider Visits at 6 months (2020)	Number of visits (proxy for increased preventative health care)	6 months from intervention start date
Primary Care Provider Visits at 12 months (2020)	Number of visits (proxy for increased preventative health care)	12 months from intervention start date
Obstetrician-Gynecologist Visits at 6 months (2020)	Number of visits (proxy for increased preventative health care)	6 months from intervention start date
Obstetrician-Gynecologist Visits at 12 months (2020)	Number of visits (proxy for increased preventative health care)	12 months from intervention start date
Breast Cancer Diagnosis at 6 months (2020)	Binary variable indicating whether the recipient was diagnosed with breast cancer	6 months from intervention start date
Breast Cancer Diagnosis at 12 months (2020)	Binary variable indicating whether the recipient was diagnosed with breast cancer	12 months from intervention start date
Emergency Department Visits at 6 months (2020)	Number of Emergency Department Visits (proxy for increased costly utilization of health system resources)	6 months from intervention start date
Emergency Department Visits at 12 months (2020)	Number of Emergency Department Visits (proxy for increased costly utilization of health system resources)	12 months from intervention start date

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mammogram Completion at 12 months (2019)	Binary variable indicating whether a mammogram was completed to be used for exploratory pre-post comparisons	12 months from 2019 intervention start date
Primary Care Provider Visits at 12 months (2019)	Number of visits to be used for exploratory pre-post comparisons (proxy for increased preventative health care)	12 months from 2019 intervention start date
Breast Cancer Diagnosis at 12 months (2019)	Binary variable indicating whether the woman was diagnosed with breast cancer	12 months from 2019 intervention start date
Emergency Department Visits at 12 months (2019)	Number of Emergency Department Visits (proxy for increased costly utilization of health system resources)	12 months from 2019 intervention start date

Collaborators and Investigators

• Sponsor: Geisinger Clinic

Study record dates

Study Major Dates

• Study Start (Actual): October 2, 2020
• Primary Completion (Actual): October 5, 2021
• Study Completion (Actual): October 5, 2021

Study Registration Dates

• First Submitted: September 4, 2020
• First Submitted That Met QC Criteria: September 14, 2020
• First Posted (Actual): September 21, 2020

Study Record Updates

• Last Update Posted (Actual): November 15, 2021
• Last Update Submitted That Met QC Criteria: November 12, 2021
• Last Verified: November 1, 2021

More Information

Terms related to this study

• Keywords: Mammography; Communication; Psychology; Mass Screening; Economics, Behavioral; Fear Appeals; Risk Reduction Behavior; Loss Frame; Reciprocity
• Other Study ID Numbers: 2020-0761

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings. The PI did not examine or analyze any data from this study prior to this registration.
• IPD Sharing Time Frame: The data will become available after publication of study results in a scientific journal and will be available as long as the Open Science Framework hosts the data.
• IPD Sharing Access Criteria: The data on the Open Science Framework will be open to anyone requesting that information.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No