Patient barriers to mammography identified during a reminder program

Background: Patient mammogram reminders are effective at increasing screening, but patient barriers remain. We evaluated patient characteristics and reported barriers for their association with mammogram completion after a reminder program. Methods: This retrospective cohort study used data from electronic records and a subgroup survey. Participants were female Kaiser Permanente Northwest health maintenance organization (HMO) members aged 50-69 who were 20 months past their last mammogram (index date) and had received a reminder intervention (n=4708). A mailed survey was completed by 340 of 667 (50.2%) women who received it. The intervention was a "mammogram due soon" postcard 20 months after the last mammogram, followed by up to two automated phone calls and one live call for nonresponders. The outcome was mammogram completion at 10 months after index date. Results: Characteristics associated with lower mammogram completion rates were aged <60 (odds ratio [OR] 0.69, p<0.0001), health plan membership <5 years (OR 0.81, p=0.019), family income <$40,000/year (OR 0.77, p=0.018), and obesity (OR 0.67, p<0.0001). Obese women were more likely than nonobese women to report "too much pain" from mammograms (31.3% vs.18.8%, p<0.01). Younger women were more likely to endorse that they were "too busy" (19.1% vs. 6.4%, p<0.001) and had more worries about mammogram accuracy (2.5 vs. 2.3 on a 5-point scale, p<0.05). Pain mediated the relationship between obesity and mammogram completion rates (indirect effect=-0.111, p=0.008). Conclusions: Important barriers to mammogram completion remain even after an effective mammogram reminder system among insured patients. Tailored interventions are necessary to overcome these barriers.