Women are more likely to start getting regular mammograms if health
information is tailored to their personal concerns, according to the
results of a Brown University study.
In this randomized clinical trial of nearly 1,400 women in
Massachusetts and Rhode Island, researchers found that a personal
approach encouraged more women to get a repeat mammogram than did
generic advice or no intervention. Health psychologist William
Rakowski, PhD, associate professor of community health at Brown
University School of Medicine, and his colleagues presented their
findings at a recent meeting of the Society of Behavioral Medicine.
They reported that about 60% of US women over 50 years old have had a
mammogram and clinical breast examination within the last year or
two, but 20% have never had one. This study tested a new way to
encourage women to have mammograms on a regular basis.
In the 4-year screening project, women recruited from a health
maintenance organization were randomly assigned to three groups. All
of the women were interviewed four times to assess their breast
cancer screening history, concerns, and actions. After each of the
first two interviews, women in one group were sent
computer-generated, personalized letters plus information tailored to
their survey responses. A second group received standard educational
information, and the third group received nothing.
Women who received personalized materials were 10% more likely to get
a repeat mammogram than were those who received none--a significant
difference and one that applied regardless of age, race, income, and education.
Four Steps to Changing Behavior
This personalized approach to changing health behavior presumes that
people go through a series of four steps before adopting a new health
habit and that all people are not equally ready to change their
behavior. The four steps are: precontemplation, contemplation,
action, and maintenance. Relapse is possible during any of these steps.
"We match the materials to the person with the objective of
nudging them one step further, rather than asking them to make a
full-fledged change right away," said Dr. Rakowski.
In the study, "precontemplation" women, for example, who
had not considered mammography received materials encouraging them to
contemplate the screening test, while "action" women, who
were beginning to have regular mammograms, were given different
information to help them maintain their good screening habits. The
screening project was funded by the National Cancer Institute.
Smoking and Mammography
In related research, Dr. Rakowski and colleagues also reported that
smoking seems to be a barrier to regular breast cancer screening.
"For some reason, women who smoked one pack or more a day were
about 9% less likely to have been screened for breast cancer than
were nonsmoking women," said Dr. Rakowski says. Furthermore,
nonsmoking women who lived with a smoker were about 10% less likely
to get mammograms than were women who lived in nonsmoking households,
added behavioral scientist Melissa Clark, PhD, an assistant professor
in the Gerontology and Health Care Research Center at Brown School of Medicine.
"Our intention is not to place more blame or raise more guilt in
the minds of smokers," said Dr. Rakowski. "Until we know
why this is happening, its important for clinicians to be aware
of the breast cancer screening status of women who smoke."
Drs. Rakowski, Clark, and colleagues found the association between
smoking and mammography rates in data from the National Health
Interview Survey, a representative sampling of the countrys
health. The annual sample sizes ranged from 2,700 to 9,800 women. The
researchers included only women who had had recent medical check-ups,
and the results were independent of age, race, income, and education.
The smoking study was funded by the Robert Wood Johnson Foundation.