How much does a reminder letter increase cervical screening among under-screened women in NSW?

Morrell, Stephen, Taylor, Richard, Zeckendorf, Sue, Niciak, Amanda, Wain, Gerard and Ross, Jayne (2005) How much does a reminder letter increase cervical screening among under-screened women in NSW?. Australian And New Zealand Journal of Public Health, 29 1: 78-84. doi:10.1111/j.1467-842X.2005.tb00753.x

Author Morrell, Stephen
Taylor, Richard
Zeckendorf, Sue
Niciak, Amanda
Wain, Gerard
Ross, Jayne
Title How much does a reminder letter increase cervical screening among under-screened women in NSW?
Journal name Australian And New Zealand Journal of Public Health   Check publisher's open access policy
ISSN 1326-0200
Publication date 2005-02
Sub-type Article (original research)
DOI 10.1111/j.1467-842X.2005.tb00753.x
Volume 29
Issue 1
Start page 78
End page 84
Total pages 7
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject 1199 Other Medical and Health Sciences
Formatted abstract
Objective: To evaluate a direct mail-out campaign to increase Pap screening rates in women who have not had a test in 48 months.

Methods: Ninety thousand under-screened women were randomised to be mailed a 48-month reminder letter to have a Pap test (n=60,000), or not to be mailed a letter (n=30,000). Differences in Pap test rates were assessed by Kaplan-Meier survival analysis, by chi(2) tests of significance between Pap test rates in letter versus no-letter groups, and by proportional hazards regression modelling of predictors of a Pap test with letter versus rid-letter as the main study variable. T-tests were conducted on mean time to Pap test to assess whether time to Pap test was significantly different between the intervention and control groups.

Results: After 90 days following each mail-out, Pap test rates in the letter group were significantly higher than in the non-letter group, by approximate totwo percentage points. After controlling for potential confounders, the hazard ratio of a Pap test within 90 days of a mail-out in the letter group was 1.5 compared with 1.0 in the no-letter group. Hazard ratios of having a Pap test within 90 days decreased significantly with time since last Pap test (p<0.0001); were significantly higher than 1.0 for most non-metropolitan areas of NSW compared with metropolitan areas; and increased significantly with age (p<0.0001). Pap test hazard ratios were not associated with socio-economic status of area of residence, but the hazard ratio was significantly higher than 1.0 if the reminder letter was sent after the Christmas/New Year break. No significant differences in mean time to Pap test were found between the letter and no-letter groups.

Conclusions and implications:
Being sent a reminder letter is associated with higher Pap testing rates in under-screened women.
Keyword Public, Environmental & Occupational Health
Q-Index Code C1
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Public Health Publications
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Created: Mon, 13 Aug 2007, 15:01:05 EST