Stage of adoption and impact of direct-mail communications with and without phone intervention on Chinese womenʹs cervical smear screening behavior

Background. The purposes of the study were to (1) assess the impact of direct-mail communications with and without phone intervention, and (2) examine the characteristics of women who were more likely to respond. Methods. Women were recruited from female family members of inpatients admitted to one of the major teaching hospitals in Taiwan (n = 424), and were randomly assigned into an intervention group, who received direct-mails and a phone follow-up, or a control group, who received placebo messages. Results. Logistic regression analysis showed that women in the intervention group (ORadj. = 2.31) and contemplation stage (ORadj. = 4.18) were more likely to receive a screening at the end of the program. Among women in the intervention group, contemplators were 5.58 times more likely to receive a screening before the phone intervention (early adopters); and 40% of the screening adopters responded after the phone intervention (late adopters). Late and early adopters were similar in their stage, age, and education. Conclusions. Stage and intervention are both significant predictors of screening adoption. The study provides justification for programs to target women in contemplation stage. It also suggests that the boost of a later phone intervention may be consequential for encouraging more women with similar demographics to take action.