Impact of mailed and automated telephone reminders on receipt of repeat mammograms: a randomized controlled trial

Abstract

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.

Figure 1

PRISM study design

Figure 2

PRISM participant recruitment and randomization ^aRandom allocation to study arms occurred prior to participant contact and recruitment. Larger numbers for the ATR and ELR groups were planned for future analysis of supplemental intervention. ^bParticipants excluded from main analysis are: (1) those with self-reported race other than white or black (EUCR=7, ATR=24, ELR=22); (2) those who received subsequent mammograms ≤10 months after enrollment mammograms (EUCR=3, ATR=9, ELR=9), and/or those who received previous mammograms ≤10 months prior to enrollment mammograms (EUCR=38, ATR=63, ELR=45).