Can tailored interventions increase mammography use among HMO women?
BACKGROUND
Telephone counseling and tailored print communications have emerged as promising methods for promoting mammography screening. However, there has been little research testing, within the same randomized field trial, of the efficacy of these two methods compared to a high-quality usual care system for enhancing screening. This study addressed the question: Compared to usual care, is tailored telephone counseling more effective than tailored print materials for promoting mammography screening?


METHODS
Three-year randomized field trial.


METHODS
One thousand ninety-nine women aged 50 and older recruited from a health maintenance organization in North Carolina.


METHODS
Women were randomized to 1 of 3 groups: (1) usual care, (2) tailored print communications, and (3) tailored telephone counseling.


RESULTS
Adherence to mammography screening based on self-reports obtained during 1995, 1996, and 1997.


RESULTS
Compared to usual care alone, telephone counseling promoted a significantly higher proportion of women having mammograms on schedule (71% vs 61%) than did tailored print (67% vs 61%) but only after the first year of intervention (during 1996). Furthermore, compared to usual care, telephone counseling was more effective than tailored print materials at promoting being on schedule with screening during 1996 and 1997 among women who were off-schedule during the previous year.


CONCLUSIONS
The effects of the intervention were most pronounced after the first intervention. Compared to usual care, telephone counseling seemed particularly effective at promoting change among nonadherent women, the group for whom the intervention was developed. These results suggest that telephone counseling, rather than tailored print, might be the preferred first-line intervention for getting nonadherent women on schedule for mammography screening. Many questions would have to be answered about why the tailored print intervention was not more powerful. Nevertheless, it is clear that additional interventions will be needed to maintain women's adherence to mammography. Medical Subject Headings (MeSH): mammography screening, telephone counseling, tailored print communications, barriers.
Lipkus
I M
IM
Cancer Prevention, Detection and Control Research Program, Duke Comprehensive Cancer Center, Duke University Medical Center, Durham, North Carolina 27710, USA. mc.duke.edu.
Rimer
B K
BK
Halabi
S
S
Strigo
T S
TS
D003362:Cost-Benefit Analysis; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008389:Marketing of Health Services / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D009657:North Carolina; D016017:Odds Ratio; D010174:Pamphlets; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D017010:Reminder Systems / Q000191:economics; D013689:Telephone