title: The impact of different communication and organizational strategies on mammography screening uptake in women aged 40-45 years.
abstract: BACKGROUND
  Several factors can influence access to population breast cancer screening. The aim of the study was to evaluate the impact of different information approaches, women's socio-demographic characteristics and organizational factors on mammography screening uptake.
  
  
  METHODS
  We selected 5744 women aged 40-45 years who were randomly assigned to be given letters with: (i) a pre-fixed appointment plus standard leaflet (Group 1); (ii) a pre-fixed appointment plus a more comprehensive booklet (Group 2); (iii) point (ii) plus the offer of a counselling session (Group 3); and (iv) an invitation to contact the centre to get information and arrange participation (Group 4).
  
  
  RESULTS
  Ninety-five women were excluded before the invitation and 5649 were randomized. After excluding undelivered letters (n = 41) and women reporting an exclusion criterion following our invitation (n = 248), the final eligible population was 5360 women. Participation rates following the first contact were 36.5, 39.9, 35.8 and 16.5% for Groups 1-4, respectively. The rates increased to 40.9, 43.6, 40.1 and 35.1% after the reminder letters. Women receiving more complete information had a higher uptake (Group 2), although not statistically significant. Differences among the four groups were maintained by controlling the effect of socio-demographic and attendance determinants. Regardless of intervention, participation was higher among married, higher educated, white-collared women, those born in northern Italy, living closer to the screening unit and with a female-collaborative doctor.
  
  
  CONCLUSIONS
  Invitation letters with a fixed appointment correlate with a higher attendance rate. Providing women with more information on procedures, risks and benefits of mammography screening does not modify their participation.
authors: Unit of Epidemiology - CPO Piemonte, Center for Cancer Prevention, Turin, Italy. livia.giordano@cpo.it
authors: Livia
authors: L
authors: Giordano
authors: Valeria
authors: V
authors: Stefanini
authors: Carlo
authors: C
authors: Senore
authors: Alfonso
authors: A
authors: Frigerio
authors: Roberta
authors: R
authors: Castagno
authors: Vincenzo
authors: V
authors: Marra
authors: Marco
authors: M
authors: Dalmasso
authors: Marco Rosselli
authors: MR
authors: del Turco
authors: Eugenio
authors: E
authors: Paci
authors: Nereo
authors: N
authors: Segnan
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000517:prevention & control; D003142:Communication; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014186:Transportation