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Interventions Targeted toward Patients to Increase Mammography Use¹

MEDTAP International, Bethesda, Maryland 20814 [K. R. Y.]; Johns Hopkins School of Hygiene and Public Health, Department of Epidemiology, Baltimore, Maryland 21205-2179 [K. R. Y.]; and Department of Medicine, Lombardi Cancer Center, Georgetown University Medical Center, Washington, D.C. 20007 [J. S. M.]

The objective of this study was to determine the effects of patient-based mammography screening strategies. We performed a meta-analysis and included United States studies that met the following criteria: (a) randomized or concurrent control design; (b) defined outcomes; and (c) data available for reanalysis. Interventions were classified as behavioral, cognitive, or sociological and further categorized by the type of control group (active versus usual care), number of interventions, and mode of intervention (interactive versus static). Data were combined using DerSimonian and Laird random effects models to yield summary effect sizes. A total of 63 interventions in 43 studies met the inclusion criteria. Behavioral interventions increased screening by 13.2% [95% confidence interval (CI), 4.7–21.2] compared with usual care, and by 13.0% (95% CI, 8.7–17.4) when using multiple strategies and 5.6% (95% CI, 0.6–10.6) when using a single intervention compared to active controls. Cognitive interventions using generic education strategies had little impact on screening, but those that used theory-based education (e.g., health belief model) increased rates by 23.6% (95% CI, 16.4–30.1) compared with usual care. Sociological interventions also increased screening rates. Interventions using a theoretical framework were the most effective in increasing screening rates. The ability of these interventions to increase screening among subgroups and improve rates of ongoing screening, as well as the costs of these strategies, is unknown and is an important area for future research.

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