The Relative Value of Educational Reminder Letters Versus Standard Reminder Letters for Annual Screening Mammography

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

B. Jo Hailey

Advisor Department



Research indicates that, while women are getting mammograms, they are not necessarily getting annual screening mammograms as recommended by the American Cancer Society. Therefore, the purpose of this study was to determine the relative value of an educational reminder letter versus a standard reminder letter sent to women age 51 years and older who were due to get their second or subsequent annual screening mammogram for having an annual mammogram. The educational reminder was developed based on components of the Health Belief Model. A total of 4,564 medical records were reviewed in order to identify women who fit the criteria for this study. The criteria being due for an annual screening mammogram, no family history, no personal history of breast cancer, previous mammogram was for screening purposes, and age 50 years and older at the time of previous mammogram. One thousand two hundred ninety-three women fit the inclusion criteria and received either the educational or the standard reminder letter. There were no differences found between the two groups for getting a mammogram within the month one was due. Over time, more women got a mammogram, but this finding was not differentiated by letter type. Post-hoc analyses revealed that six months after the women were due, 72% had had a mammogram, regardless of letter type. Additional analyses revealed that older women were less likely to get a mammogram. The educational letter used in this study did not produce differences among women who were to get an annual screening mammogram when compared to those who received a standard reminder letter. It is possible that the educational letter was not salient enough to produce differences. Also, a high number of women received a mammogram within 18 months of their previous screening. This high number indicates that women are getting repeat mammograms, but not necessarily on an annual basis.