Slater, J. S., Henly, G. A., Ha, C. N., Malone, M. E., Nyman, J. A., Diaz, S., & McGovern, P. G. (2005). Effect of direct mail as a population-based strategy to increase mammography use among low-income underinsured women ages 40 to 64 years. Cancer Epidemiology, Biomarkers and Prevention, 14(10), 2346-2352.
Using Direct Mail to Increase Screening Mammography
|Program Title||Using Direct Mail to Increase Screening Mammography|
|Purpose||Designed to help increase breast cancer screening among low-income, underinsured women. (2005)|
|Program Focus||Awareness building and Behavior Modification|
|Population Focus||Medically Underserved|
|Topic||Breast Cancer Screening|
|Age||Adults (40-65 years)|
|Race/Ethnicity||This information has not been reported.|
|Funded by||NCI (Grant number(s): CA78514 )|
|User Reviews||(Be the first to write a review for this program)|
A randomized, controlled trial was used to test the efficacy of a direct mail intervention as a population-wide approach for increasing screening mammography use among women who are eligible for free screening services through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Women in the first intervention condition received two different mailers, sent approximately one month apart. Women in the second intervention condition received the same mailers plus a $10 monetary incentive for those who complete a mammogram within approximately one year. These groups were compared to a no-intervention control group. Women in all three study groups may have been exposed to other ongoing NBCCEDP program recruitment activities, including efforts by community health agency recruiters, occasional print and broadcast media advertisements, and individual participating clinics promoting the program to their patients.
The primary outcome was completion of a mammogram through Sage, the NBCCEDP program in Minnesota, within 13 months after the intervention's onset.
The sampling frame provided 145,467 possible participants for the study, with a mean age of 49.7 years. Cases were split into low versus high mammography rate clusters (MRC), based on NCI's Consumer Health Profiles that reflect associations between health behaviors and Claritas PRIZM cluster assignment for each woman. Of the 145,467 possible participants, 34,540 (23.7%) were from low MRC strata and 110,927 (76.3%) were from high MRC strata. Cases were randomized to each group, although since the high MRC stratum was much larger, a higher percentage of high MRC cases were allocated to the control group. In total, 25,633 participants were randomly assigned to the mail only group, 25,633 were assigned to the mail plus incentive group, and 94,201 were assigned to the control group.
After one year, both intervention groups had significantly higher mammography rates than the control group (p<.001). The treatment group that received both the mailings plus the incentive had a significantly higher rate than the mail only group (p<.01).
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