Research articlePromoting mammography: Results of a randomized trial of telephone counseling and a medical practice intervention
Section snippets
Study population and eligibility criteria
The UMMS study population comprised women, aged 50–80 years, who were members of two independent physician association (IPA) model HMOs serving central and southeastern Massachusetts and whose primary care physicians (PCP) were eligible for the study. Eligible PCPs were family, internal, or general practitioners who: (1) were either solo practitioners or members of a group of 10 or fewer physicians, (2) had a minimum of 16 women who were HMO enrollees between the ages of 50 and 80 years, and
Results
There was no difference in response rate to the final survey by intervention assignment. Response to the final survey was significantly associated with prior mammogram utilization, marital status, income, educational level, provider recommendation to have a mammogram, and attitude toward mammography, but not associated with age, perceived vulnerability, or intervention group.
Table 1 shows the baseline characteristics of the study subjects who completed the final survey by intervention arm.Only
Discussion
This study demonstrates that BSTC is modestly effective in encouraging women whose utilization has lapsed by ≥24 months (i.e., former users) to become regular users. For women who were recent but not regular users at the start of the study, both interventions were associated with substantial increases in utilization, but the increases were no greater than the increase associated with mailed reminders alone (the control condition). For women who had never had a mammogram at baseline, only a
Conclusion
This study demonstrates the importance of prior screening behavior in predicting subsequent behavior, an association that has been demonstrated by other investigators.13, 55 Our results indicate that even in a late period of screening adoption, BSTC has a place in the strategies of HMOs and PCPs in encouraging lapsed screeners to become regular users. For the small group of women who remain non-users of this technology in the later stages of adoption, more intensive interventions should be
Acknowledgements
This study was funded by the NIH grant R01 CA60130 and reviewed and approved by the Committee for the Protection of Human Subjects in Research at the University of Massachusetts Medical School, Worcester, Massachusetts.
The authors are grateful to Harvard Pilgrim Health Care and CIGNA Health Care of Massachusetts, Inc., for their support of the project and ongoing cooperation and assistance throughout the study.
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