title: Can older women be motivated to attend for their final Papanicolaou tests? The use of targeted and general personalised reminder letters.
abstract: BACKGROUND
  Australian guidelines allow women to cease having Papanicolaou (Pap) tests at the age of 70, providing they have had two negative smears in the previous 5 years. In Victoria, a standard reminder letter system is in place and women receive one reminder letter 27 months after their last Pap test.
  
  
  METHODS
  A targeted letter informed by qualitative research was developed to specifically encourage older women to have a final Pap test. The Victorian Cervical Cytology Registry (VCCR) was used to identify 15,000 women aged 65-69 who had not had a Pap test for at least 3 years and up to 17 years. Women were randomly allocated to receive either no letter (control group), the targeted letter or a personally addressed general reminder letter.
  
  
  RESULTS
  At 11 weeks follow-up, 4.3% of women (CI 3.7-4.8%) who received the targeted letter had attended for a Pap test compared with 4.7% (CI 4.1-5.3%) of those receiving the general letter and 1.6% (CI 1.2-1.9%) of the control group. Effectiveness was limited to women whose test was no more than 10 years overdue, and was particularly strong for those whose test was 3-5 years overdue.
  
  
  CONCLUSIONS
  This suggests that a reminder letter was effective, but that targeting the information in the letter did not further improve screening attendance. A second reminder letter sent to women before their Pap test is more than 5 years overdue has potential for increasing the number of women attending for screening.
authors.affiliation: Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Carlton South, Victoria 3053, Australia. Robyn.Mullins@cancervic.org.au
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Mullins
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data; D065006:Papanicolaou Test; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data*