Evaluation of Mailers Promoting Mammogram Screening

Study Overview
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Brief Summary
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In this evaluation, 3 different versions of mailers promoting annual mammograms are being sent to women on the month of their 50th and 64th birthdays. The researchers hypothesize that the use of behavioral nudges in the mailers should lead to increased uptake in mammogram screening.

Detailed Description
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Mammogram screening for women, starting at age 50, can significantly reduce the risk of complications due to breast cancer. As part of an existing outreach campaign, the health system mails a postcard and small gift (pink socks) to women on the month of their 50th and 64th birthdays to promote annual mammogram screening. The researchers are evaluating two new versions of the mailers against a standard mailer to see which version leads to greater uptake in mammograms. The new mailers have content that applies behavioral nudge theory - specifically, loss frames and fear appeals - to encourage taking action. One of the two new versions does not include the small gift, to test whether its inclusion or exclusion has any effect on mammogram screening.

Official Title
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Evaluation of Postcard Mailers Enhanced With Behavioral Nudges to Promote Mammogram Screening

Conditions
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Breast Cancer

Intervention / Treatment
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* Behavioral: Postcard
* Behavioral: Small Gift
* Behavioral: Loss Frame and Fear Appeals


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female Geisinger Health Plan members turning 50 and 64 in that month For the 2020 campaign, birthdays from June 2020 (as opposed to August 2020) will be included due to a temporary suspension of the outreach program due to the COVID-19 pandemic since June For the pre-post examination of the 2019 campaign, all months in that year will be included Exclusion Criteria: - Members who are on the do not contact list at Geisinger Health Plan

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Factorial Assignment
Interventional Model Description: 1 x 3 design
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard Mailer and Small Gift<br>A postcard encourages mammograms and includes a small gift. | Behavioral: Postcard<br>* The postcard includes appeals to get annual mammograms and provides information for ordering a mammogram.<br>Behavioral: Small Gift<br>* Pink socks are included in the mailer. The gift increases salience of the mailer and it potentially promotes reciprocation from the recipient in the form of ordering a mammogram.<br>|
| Experimental: Mailer with Loss Frame, Risks, and Small Gift<br>The postcard is enhanced with language that further emphasizes the risks but also clearly describes how early detection with a test can reduce those risks; a small gift is included. | Behavioral: Postcard<br>* The postcard includes appeals to get annual mammograms and provides information for ordering a mammogram.<br>Behavioral: Small Gift<br>* Pink socks are included in the mailer. The gift increases salience of the mailer and it potentially promotes reciprocation from the recipient in the form of ordering a mammogram.<br>Behavioral: Loss Frame and Fear Appeals<br>* The postcard is enhanced with language that frames the situation in terms of losses. It also uses fear appeals by stating the risks of breast cancer, while also stating that a mammogram screening is an accessible way to address those risks.<br>|
| Experimental: Mailer with Loss Frame, Risks, and No Gift<br>The postcard is enhanced with language that further emphasizes the risks but also clearly describes how early detection with a test can reduce those risks; the small gift is not included. | Behavioral: Postcard<br>* The postcard includes appeals to get annual mammograms and provides information for ordering a mammogram.<br>Behavioral: Loss Frame and Fear Appeals<br>* The postcard is enhanced with language that frames the situation in terms of losses. It also uses fear appeals by stating the risks of breast cancer, while also stating that a mammogram screening is an accessible way to address those risks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mammogram Completion at 6 months (2020) | Binary variable indicating whether a mammogram was completed | 6 months from intervention start date | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mammogram Completion at 12 months (2020) | Binary variable indicating whether a mammogram was completed (a longer time frame allows for late responses) | 12 months from intervention start date | 
| Primary Care Provider Visits at 6 months (2020) | Number of visits (proxy for increased preventative health care) | 6 months from intervention start date | 
| Primary Care Provider Visits at 12 months (2020) | Number of visits (proxy for increased preventative health care) | 12 months from intervention start date | 
| Obstetrician-Gynecologist Visits at 6 months (2020) | Number of visits (proxy for increased preventative health care) | 6 months from intervention start date | 
| Obstetrician-Gynecologist Visits at 12 months (2020) | Number of visits (proxy for increased preventative health care) | 12 months from intervention start date | 
| Breast Cancer Diagnosis at 6 months (2020) | Binary variable indicating whether the recipient was diagnosed with breast cancer | 6 months from intervention start date | 
| Breast Cancer Diagnosis at 12 months (2020) | Binary variable indicating whether the recipient was diagnosed with breast cancer | 12 months from intervention start date | 
| Emergency Department Visits at 6 months (2020) | Number of Emergency Department Visits (proxy for increased costly utilization of health system resources) | 6 months from intervention start date | 
| Emergency Department Visits at 12 months (2020) | Number of Emergency Department Visits (proxy for increased costly utilization of health system resources) | 12 months from intervention start date | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mass Screening, Communication, Mammography, Risk Reduction Behavior, Economics, Behavioral, Psychology, Loss Frame, Fear Appeals, Reciprocity