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Women’s views on reminder letters for screening mammography

Mixed methods study of women from 23 family health networks

Tina Karwalajtys, PhD
Research coordinator in the Department of Family Medicine at McMaster University in Hamilton, Ont.

Lynne Lohfeld, PhD
Associate Professor in the Department of Clinical Epidemiology and Biostatistics at McMaster University.

Stephanie Laryea
Research assistant in the Department of Family Medicine at McMaster University.

Kelly Anderson, MSc
Doctoral student in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University in Montreal, Que.

Stefanie Roder, PhD
Research coordinator with the Foundation for Medical Practice Education in Hamilton.

Rolf J. Sebaldt, MD
Associate Professor in the Department of Medicine at McMaster University.

Correspondence Dr Janusz Kaczorowski, UBC Department of Family Practice, Suite 320, 5950 University Blvd, Vancouver, BC V6T 1Z3; telephone 604 827-4396; fax 604 827-4184; e-mail janusz.kaczorowski{at}familymed.ubc.ca

OBJECTIVE To explore women’s perspectives on the acceptability and content of reminder letters for screening mammography from their family physicians, as well as such letters’ effect on screening intentions.

DESIGN Cross-sectional mailed survey followed by focus groups with a subgroup of respondents.

SETTING Ontario.

PARTICIPANTS One family physician was randomly selected from each of 23 family health networks and primary care networks participating in a demonstration project to increase the delivery of preventive services. From the practice roster of each physician, up to 35 randomly selected women aged 50 to 69 years who were due or overdue for screening mammograms and who had received reminder letters from their family physicians within the past 6 months were surveyed.

MAIN OUTCOME MEASURES Recall of having received reminder letters and of their content, influence of the letters on decisions to have mammograms, and interest in receiving future reminder letters. Focus group interviews with survey respondents explored the survey findings in greater depth using a standardized interview guide.

RESULTS The response rate to the survey was 55.7% (384 of 689), and 45.1% (173 of 384) of responding women reported having mammograms in the past 6 months. Among women who recalled receiving letters and either making appointments for or having mammograms, 74.8% (122 of 163) indicated that the letters substantially influenced their decisions. Most respondents (77.1% [296 of 384]) indicated that they would like to continue to receive reminders, and 28.9% (111 of 384) indicated that they would like to receive additional information about mammograms. Participants in 2 focus groups (n = 3 and n = 5) indicated that they thought letters reflected a positive attitude of physicians toward mammography screening. They also commented that newly eligible women had different information needs than women who had had mammograms done in the past.

CONCLUSION Reminder letters were considered by participants to be useful and appeared to influence women’s decisions to undergo mammography screening.