Segura J M, Castells X, Casamitjana M, Macià F, Porta M, Katz S J
CAP Dr. Sayé, Institut Català de la Salut, Barcelona, Spain.
Prev Med. 2001 Oct;33(4):325-32. doi: 10.1006/pmed.2001.0891.
The objective of this study was to compare the response received by a population-based breast cancer screening program, according to three different invitation strategies: letters sent by mail from the program (program group), letters sent by mail from the Primary Health Care Team (PHT group), and direct contact through a trained professional (direct contact group).
We used a cluster-randomized controlled trial with assignment to invitation group using home address. Nine hundred eighty-six women of Barcelona (Spain), ages 50 to 64 years, were invited to participate in the program. The main outcome used was the response rate after the first invitation.
Five hundred sixty-four women accepted the invitation (57.2%). The highest response rate was achieved in the direct contact group (63.5%), followed by the PHT group (55.6%), the program group being the one that attained the lowest response rate (52.1%). The direct contact group had a higher probability of participating than the PHT group (RR = 1.14, P = 0.037) or the program group (RR = 1.22, P = 0.003). The response rate in the direct contact group was 72.1% when the letter was received by the subject herself. The increase in response occurred particularly among women of lower educational level.
Inviting women to participate in a breast cancer screening program through direct contact by trained personnel increased participation rate compared with mailed-letter methods. The positive effect appeared restricted to women with lower educational levels.
本研究的目的是比较基于人群的乳腺癌筛查项目根据三种不同邀请策略所获得的响应情况：由项目组通过邮件发送信件（项目组）、由初级卫生保健团队通过邮件发送信件（初级卫生保健团队组）以及通过经过培训的专业人员进行直接联系（直接联系组）。
我们采用了一项整群随机对照试验，根据家庭住址将其分配至邀请组。邀请了西班牙巴塞罗那的986名年龄在50至64岁之间的女性参与该项目。主要观察指标是首次邀请后的响应率。
564名女性接受了邀请（57.2%）。直接联系组的响应率最高（63.5%），其次是初级卫生保健团队组（55.6%），项目组的响应率最低（52.1%）。直接联系组参与的可能性高于初级卫生保健团队组（相对风险 = 1.14，P = 0.037）或项目组（相对风险 = 1.22，P = 0.003）。当信件由受试者本人收到时，直接联系组的响应率为72.1%。响应率的提高尤其发生在教育水平较低的女性中。
与邮寄信件的方法相比，通过经过培训的人员直接联系邀请女性参与乳腺癌筛查项目可提高参与率。这种积极效果似乎仅限于教育水平较低的女性。
