Slater Jonathan S, Henly George A, Ha Chung Nim, Malone Michael E, Nyman John A, Diaz Sarah, McGovern Paul G
Cancer Control Section, Minnesota Department of Health, 717 Delaware Street Southeast, P.O. Box 9441, Minneapolis, MN 55440-9441, USA.
Cancer Epidemiol Biomarkers Prev. 2005 Oct;14(10):2346-52. doi: 10.1158/1055-9965.EPI-05-0034.
Women with inadequate health insurance have lower mammography rates than the general population. Finding successful strategies to enroll eligible women is an ongoing challenge for the National Breast and Cervical Cancer Early Detection Program. To test the effectiveness of a population-based strategy to increase mammography utilization among low-income underinsured women ages 40 to 64 years, a randomized trial was conducted to assess the effect of two mailed interventions on mammography utilization through Sage, the National Breast and Cervical Cancer Early Detection Program in Minnesota. Women (N = 145,467) ages 40 to 63 years [mean (SD), 49.7 (6.8)] with estimated household incomes below 50,000 US dollars (47.9% were < 35,000 US dollars) from a commercial database were randomized to three groups: Mail, Mail Plus Incentive, or Control. Both the Mail and the Mail Plus Incentive groups received two simple mailings prompting them to call a toll-free number to access free mammography services. The Mail Plus Incentive intervention offered a small monetary incentive for a completed mammogram. After 1 year, both intervention groups had significantly higher Sage mammography rates than the Controls, and the Mail Plus Incentive group had a significantly higher rate than the Mail group. The Mail and Mail Plus Incentive interventions were estimated to produce increases in Sage screening rates of 0.23% and 0.75%, respectively, beyond the composite Control rate of 0.83%. Direct mail is an effective strategy for increasing mammography use through Sage. Coupling direct mail with an incentive significantly enhances the intervention's effectiveness. Direct mail should be considered as a strategy to increase mammography use among low-income, medically underserved women.
医疗保险不足的女性进行乳房X光检查的比率低于普通人群。找到成功的策略让符合条件的女性参保，是国家乳腺癌和宫颈癌早期检测项目一直面临的挑战。为了测试一项基于人群的策略对40至64岁低收入、保险不足女性乳房X光检查利用率的有效性，进行了一项随机试验，以评估两种邮寄干预措施通过明尼苏达州的国家乳腺癌和宫颈癌早期检测项目Sage对乳房X光检查利用率的影响。从一个商业数据库中选取了年龄在40至63岁[平均（标准差），49.7（6.8）]、估计家庭收入低于5万美元（47.9%低于3.5万美元）的女性（N = 145,467），随机分为三组：邮寄组、邮寄加激励组或对照组。邮寄组和邮寄加激励组都收到了两份简单的邮件，促使她们拨打免费电话以获得免费乳房X光检查服务。邮寄加激励干预措施为完成乳房X光检查提供了小额金钱奖励。1年后，两个干预组的Sage乳房X光检查率均显著高于对照组，且邮寄加激励组的比率显著高于邮寄组。据估计，邮寄组和邮寄加激励干预措施分别使Sage筛查率比综合对照组的0.83%提高了0.23%和0.75%。直接邮寄是通过Sage提高乳房X光检查使用率的有效策略。将直接邮寄与激励措施相结合可显著提高干预效果。应考虑将直接邮寄作为提高低收入、医疗服务不足女性乳房X光检查使用率的一种策略。
