Comparative effectiveness of mailed reminder letters on mammography screening compliance

Prev Med. 2012 Aug;55(2):127-30. doi: 10.1016/j.ypmed.2012.05.009. Epub 2012 May 22.


Objective: Reminder letters are effective at prompting women to schedule mammograms. Less well studied are reminders addressing multiple preventive service recommendations. We compared the effectiveness of a mammogram-specific reminder sent when a woman was due for a mammogram to a reminder letter addressing multiple preventive services and sent on a woman's birthday on mammography receipt.

Methods: The study included 48,583 women 52-74 years enrolled in Group Health Cooperative, a health plan in Washington State. From 2005 to 2009, women were mailed 88,605 mammogram-specific or birthday letters. In this one group pretest-posttest study, we modeled the odds of obtaining a screening mammogram after receiving a letter by reminder type using logistic regression, controlling for demographic and healthcare use characteristics and stratifying by whether women were overdue or up-to-date with mammography at the mailing.

Results: Among women up-to-date with screening, birthday letters were negatively associated with mammography receipt compared to mammogram-specific letters (birthday letters with 1-2 recommendations: OR=0.73; 95% CI:0.68-0.79; 3 recommendations: OR=0.74; 95% CI:0.69-0.78; 4-8 recommendations: OR=0.62 95% CI:0.55-0.68) after. Among overdue women, birthday letters with 4-8 recommendations were negatively associated with mammography receipt.

Conclusions: Transitioning from mammogram-specific reminder letters to multiple preventive service birthday letters was associated with decreased mammography receipt.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Anniversaries and Special Events
  • Breast Neoplasms / diagnosis*
  • Comparative Effectiveness Research
  • Correspondence as Topic
  • Esthetics
  • Female
  • Humans
  • Logistic Models
  • Mammography / psychology*
  • Mass Screening / psychology*
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Patient Compliance / psychology*
  • Patient Compliance / statistics & numerical data
  • Postal Service
  • Preventive Health Services / methods
  • Reinforcement, Psychology
  • Reminder Systems*
  • Washington