Screening rarely screened women: time-to-service and 24-month outcomes of tailored interventions

Prev Med. 2003 Nov;37(5):442-50. doi: 10.1016/s0091-7435(03)00165-8.


Background: Managed care organizations and others reaching out to underscreened women seek strategies to encourage mammogram and Pap screening.

Methods: Female HMO members aged 50-69 years and overdue for a mammogram and a Pap test (n = 501) were followed for 24 months after interventions began. An Outreach intervention (tailored letters and motivational telephone interviews), an Inreach intervention (motivational interview delivered in clinics), and a Combined Inreach/Outreach intervention were compared to Usual Care at 24 months. Logistic regression and Cox hazard models examined predictors of obtaining screening services and time-to-service, respectively.

Results: Compared with Usual Care, the odds of Outreach women aged 50-64 obtaining a mammogram (OR = 2.06; 95% CI = 1.59-5.29), a Pap test (OR = 1.97; 95% CI = 1.12-3.53), or both (OR = 2.53; 95% CI = 1.40-4.63) remained significantly increased at 24 months. The average time-to-service for Outreach women was reduced by 4 months. Outreach effects persisted despite intensive, ongoing health plan efforts to improve screening of all women.

Conclusions: This brief, tailored outreach intervention was an effective strategy for encouraging cervical and breast cancer screening among women overdue for both screening services. It also shortened time-to-service, an important benefit for early detection and treatment. Alternative strategies are needed for women who remain unscreened.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Community-Institutional Relations*
  • Correspondence as Topic
  • Female
  • Health Education / organization & administration*
  • Health Maintenance Organizations
  • Humans
  • Logistic Models
  • Mammography / psychology
  • Mammography / statistics & numerical data*
  • Mass Screening / organization & administration*
  • Middle Aged
  • Motivation
  • Northwestern United States
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Predictive Value of Tests
  • Program Evaluation
  • Proportional Hazards Models
  • Reminder Systems
  • Telephone
  • Time Factors
  • Vaginal Smears / psychology
  • Vaginal Smears / statistics & numerical data*
  • Women's Health