title: Finding the minimal intervention needed for sustained mammography adherence.
abstract: BACKGROUND
  Regular adherence to mammography screening saves lives, yet few women receive regular mammograms.
  
  
  METHODS
  RCT.
  
  
  METHODS
  Participants were recruited through a state employee health plan. All were women aged 40-75 years and had recent mammograms prior to enrollment (n=3547). Data were collected from 2004 to 2009.
  
  
  METHODS
  Trial tested efficacy of a two-step adaptively-designed intervention to increase mammography adherence over 4 years. The first intervention step consisted of three reminder types: enhanced usual care reminders (EUCR); enhanced letter reminders (ELR); both delivered by mail, and automated telephone reminders (ATR). After delivery of reminders, women who became off-schedule in any of the 4 years received a second step of supplemental interventions. Three supplemental intervention arms contained priming letters and telephone counseling: barriers only (BarriCall); barriers plus positive consequences of getting mammograms (BarriConCall+); and barriers plus negative consequences of not getting mammograms (BarriConCall-).
  
  
  METHODS
  Average cumulative number of days non-adherent to mammography over 4 years based on annual screening guidelines (analyses conducted in 2009).
  
  
  RESULTS
  All reminders performed equally well in reducing number of days of non-adherence. Women randomized to receive supplemental interventions had significantly fewer days of non-adherence compared to women who received EUCR (p=0.0003). BarrConCall+ and BarrConCall- conditions did not significantly differ in days non-adherent compared to women in the barriers-only condition (BarriCon).
  
  
  CONCLUSIONS
  The minimal intervention needed for sustained mammography use is a combination of a reminder followed by a priming letter and barrier-specific telephone counseling for women who become off-schedule. Additional costs associated with supplemental interventions should be considered by organizations deciding which interventions to use.
  
  
  BACKGROUND
  NCT01148875.
authors.affiliation: Division of General Internal Medicine, Duke University Medical Center and Center for Health Services Research in Primary Care, Durham VAMC, Durham, North Carolina 27705, USA. j.gierisch@duke.edu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Gierisch
authors.forename: Jessica T
authors.initials: JT
authors.lastname: DeFrank
authors.forename: J Michael
authors.initials: JM
authors.lastname: Bowling
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Rimer
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Matuszewski
authors.forename: David
authors.initials: D
authors.lastname: Farrell
authors.forename: Celette Sugg
authors.initials: CS
authors.lastname: Skinner
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control; D003376:Counseling / Q000379:methods; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009657:North Carolina; D010349:Patient Compliance; D011177:Postal Service; D017010:Reminder Systems; D013689:Telephone