Finding the minimal intervention needed for sustained mammography adherence

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.

Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1. PRISM study design

a Random allocation to study arms occurred prior to participant contact and recruitment. Larger numbers for ATR and ELR were planned for analysis of supplemental interventions. Equal proportions of participants were allocated to supplemental interventions. b Supplemental intervention for non-adherent women in any year. PRISM, Personally Relevant Information on Screening Mammography