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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard Mailer and Small Gift | Active Comparator | A postcard encourages mammograms and includes a small gift. |
|
| Mailer with Loss Frame, Risks, and Small Gift | Experimental | 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. |
|
| Mailer with Loss Frame, Risks, and No Gift | Experimental | 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. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Postcard | Behavioral | The postcard includes appeals to get annual mammograms and provides information for ordering a mammogram. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Mammogram Completion at 6 months (2020) | Binary variable indicating whether a mammogram was completed | 6 months from intervention start date |
| 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) |
| Measure | Description | Time Frame |
|---|---|---|
| Mammogram Completion at 12 months (2019) | Binary variable indicating whether a mammogram was completed to be used for exploratory pre-post comparisons | 12 months from 2019 intervention start date |
| Primary Care Provider Visits at 12 months (2019) |
Inclusion Criteria:
Exclusion Criteria:
- Members who are on the do not contact list at Geisinger Health Plan
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| Name | Affiliation | Role |
|---|---|---|
| Amir Goren, PhD | Geisinger Clinic | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Geisinger | Danville | Pennsylvania | 17822 | United States |
Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings. The PI did not examine or analyze any data from this study prior to this registration.
The data will become available after publication of study results in a scientific journal and will be available as long as the Open Science Framework hosts the data.
The data on the Open Science Framework will be open to anyone requesting that information.
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 11, 2021 | Jun 18, 2021 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D001943 | Breast Neoplasms |
| D003142 | Communication |
| D040242 | Risk Reduction Behavior |
| D001519 | Behavior |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D001941 | Breast Diseases |
| D012871 | Skin Diseases |
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1 x 3 design
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Participants and providers are not aware of the different mailer versions.
| Small Gift | Behavioral | 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. |
|
| Loss Frame and Fear Appeals | Behavioral | 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. |
|
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 |
Number of visits to be used for exploratory pre-post comparisons (proxy for increased preventative health care)
| 12 months from 2019 intervention start date |
| Breast Cancer Diagnosis at 12 months (2019) | Binary variable indicating whether the woman was diagnosed with breast cancer | 12 months from 2019 intervention start date |
| Emergency Department Visits at 12 months (2019) | Number of Emergency Department Visits (proxy for increased costly utilization of health system resources) | 12 months from 2019 intervention start date |
| D017437 |
| Skin and Connective Tissue Diseases |