Implementation and process evaluation of three interventions to promote screening mammograms delivered for 4 years in a large primary care population

UMMS Affiliation

Department of Family Medicine and Community Health; Department of Medicine, Division of Hematology Oncology; Department of Medicine, Division of Preventive and Behavioral Medicine; Meyers Primary Care Institute

Publication Date


Document Type



Counseling | Health Services Administration | Health Services Research | Neoplasms | Public Health Education and Promotion | Radiology | Translational Medical Research | Women's Health


The optimal form of outreach to promote repeated, on time screening mammograms in primary care has not been established. The purpose of this study is to assess the implementation process and process outcomes for three interventions for promoting biannual screening mammography in a randomized trial. In a large urban primary care practice over a 4-year period, we randomized women aged 40-85 and eligible for mammograms to three interventions: reminder letter only (LO), reminder letter + reminder call (RC), and reminder letter + counseling call (CC). We tracked information system development, staff training, patient and provider recruitment, reach, dose delivered and received, fidelity, and context measures. Ninety-three of 95 providers approved participation by 80% (23,999) of age-eligible patients, of whom only 207 (0.9%) opted not to receive any intervention. Of 9161 initial reminder letters mailed to women coming due or overdue for mammograms, 0.8% were undeliverable. Of women in the RC and CC arms unresponsive to the first reminder letter (n = 3982), 71.4% were called and reached, and of those, 49.1% scheduled a mammogram. Only 33.4% of women reached in the CC arm received full counseling, and women in the CC arm were less likely to schedule a mammogram than those in the RC arm. Implementing mail and telephone mammography reminders is feasible and acceptable in a large urban practice and reaches a majority of patients. Many schedule a mammogram when reached. A reminder letter followed by a simple reminder call if needed may be the optimal approach to promoting screening mammograms.


Breast cancer, Mammogram, Reminder system, Screening, Telephone counseling

DOI of Published Version



Transl Behav Med. 2017 Sep;7(3):547-556. doi: 10.1007/s13142-017-0497-x. Link to article on publisher's site

Journal/Book/Conference Title

Translational behavioral medicine

Related Resources

Link to Article in PubMed

PubMed ID