Article Figures & Data
Tables
Characteristics No. Percent References Studies 46 100.0 Study design Randomized controlled trial* 31 67.4 78 ,83–89 ,93–95 ,97 ,98 ,101 ,102–104 ,106–109 ,111–113 ,116 ,118–121 ,123 ,124 Concurrently controlled 15 32.6 79 ,82 ,90 ,92 ,96 ,99 ,100 ,105 ,110 ,114 ,115 ,117 ,122 Type of control Usual care 30 65.2 78–84 ,87–89 ,92–100 ,102 ,107 ,109 ,110 ,112 ,114 ,115 ,117 ,122–124 Active control 16 34.8 85 ,86 ,90 ,101 ,103–106 ,108 ,111 ,113 ,116 ,118–121 Interventions 63 100.0 Intervention target Patients 24 38.1 78 ,80–89 ,94 ,96 ,100 ,102 ,103 ,111–113 ,116 ,122 Physicians 25 39.7 85 ,86 ,90 ,92 ,93 ,95 ,97 ,101 ,104 ,107 ,108 ,111 ,114 ,115 ,118–121 ,124 Patients and physicians 12 19.0 79 ,85 ,98 ,99 ,106 ,109–111 ,116 ,121 ,123 ,124 System 2 3.2 105 ,117 Intervention strategy Behavioral 22 34.9 85 ,86 ,90 ,92 ,93 ,95–97 ,101 ,103 ,104 ,107 ,109 ,111 ,115 ,116 ,118–121 ,124 Cognitive 5 7.9 97 ,102 ,108 ,113 ,119 Sociologic 5 7.9 80 ,83 ,84 ,87 ,100 Behavioral and cognitive 10 15.9 85 ,94 ,97–99 ,106 ,110 ,112 ,114 ,121 Cognitive and sociologic 3 4.8 78 ,88 ,89 Behavioral, cognitive, and sociologic 5 7.9 79 ,81 ,82 ,122 ,123 Intervention content Behavioral strategy Postcard or letter reminder 16 25.4 79 ,85 ,86 ,94 ,103 ,106 ,111 ,112 ,116 ,123 ,124 Telephone reminder 2 3.2 103 ,86 Health diary 2 3.2 96 ,99 Chart reminder 22 34.9 85 ,86 ,95 ,98 ,106 ,107 ,108 ,109 ,110 ,111 ,114 ,115 ,116 ,118 ,119 ,121 ,123 ,124 Office reminders or poster display 3 4.8 79 ,99 ,110 Patient-carried prompt 4 6.3 98 ,106 ,109 ,120 Flow sheet or checklist requiring completion 9 14.3 90 ,92 ,93 ,97 ,104 ,106 ,108 ,110 ,116 Mass media reminders 1 1.6 81 Financial incentives 3 4.8 82 ,101 ,122 Cognitive strategy Educational letter or pamphlet 13 20.6 79 ,81 ,82 ,85 ,94 ,99 ,102 ,106 ,113 ,121 ,123 Telephone or in-person counseling 3 4.8 79 ,112 ,121 Educational mass media 2 3.2 78 ,79 Educational workshop or presentation 9 14.3 78 ,79 ,97 ,98 ,106 ,110 ,114 ,123 Audit with feedback 5 7.9 97 ,106 ,108 ,119 Sociologic strategy Peer or lay health workers 10 15.9 78 ,79 ,80 ,82 ,83 ,84 ,87 ,88 ,100 ,122 Culturally sensitive videotape 3 4.8 80 ,81 ,89 Outcome measurement Self-report 15 32.6 78–84 ,87,88 ,97 ,99 ,100 ,102 ,112 ,113 Chart audit 23 50.0 89 ,90 ,92–96 ,98 ,101 ,105–110 ,114 ,115 ,118 ,120–124 Claims or electronic record 10 21.7 83 ,85 ,86 ,103 ,104 ,111 ,116–119 Patient age-group <40 years 14 30.4 82 ,84–89 ,93 ,100 ,106 ,111 ,113 ,117 ,121 40–49 years 23 50.0 78 ,80 ,82–84 ,86–89 ,93 ,97 ,100 ,102 ,103 ,106 ,108 ,109 ,111–113 ,116 ,117 ,124 50–59 years 28 60.9 78 ,80 ,82–84 ,87–89 ,92 ,93 ,95–100 ,103 ,104 ,106–109 ,112 ,113 ,115–117 ,124 60+ years 19 41.3 79 ,80 ,84 ,87 ,89 ,93–95 ,97 ,98 ,100 ,103 ,104–106 ,112 ,113 ,117 ,120 Not stated 9 19.6 81 ,90 ,101 ,110 ,114 ,118 ,119 ,122 ,123 Patient race >20% African American 19 41.3 79 ,85 ,87 ,89 ,92 ,98 ,99 ,101 ,104–108 ,111 ,113 ,115 ,120 ,122 ,124 >20% Hispanic, Latina 6 13.0 80 ,84 ,89 ,96 ,98 ,106 >20% Asian, Pacific Islander 3 6.5 81 ,82 ,100 >20% Native American 2 4.3 88 ,117 >20% White 12 26.1 78 ,83 ,98 ,102 ,103 ,108 ,109 ,111 ,113 ,115 ,120 ,124 Not stated 14 30.4 86 ,90 ,93–95 ,97 ,110 ,112 ,114 ,116 ,118 ,119 ,121 ,123 Percentage with health insurance <50% 4 8.7 80 ,84 ,88 ,89 50–74% 4 8.7 81 ,98 ,111 ,113 75%+ 16 34.8 78 ,82 ,83 ,85 ,86 ,92 ,94 ,99 ,101 ,103 ,105 ,106 ,108 ,109 ,112 ,116 Not stated 22 47.8 79 ,87 ,90 ,93 ,95–97 ,100 ,102 ,104 ,107 ,110 ,114 ,115 ,117–124 Previous Papanicolaou smear use 0–24% 3 6.5 78 ,103 ,121 25–49% 10 21.7 82–85 ,88 ,90 ,98 ,102 ,111 ,117 50–74% 6 13.0 79 ,81 ,87 ,92 ,106 ,114 75%+ 1 2.2 78 Not stated 29 63.0 80 ,83 ,86 ,89 ,93–97 ,99–101 ,103 ,104 ,105 ,107–110 ,112 ,113 ,115 ,116 ,118–120 ,122–124 Time for assessment <3 months 1 2.2 90 3–6 months 12 26.1 84 ,89 ,94–96 ,99 ,102 ,104 ,114–116 ,121 6–12 months 13 28.3 86 ,93 ,103 ,105 ,108 ,111 ,117 ,119 ,120 ,122 ,124 12+ months 20 43.4 78–83 ,85 ,87 ,88 ,92 ,97 ,98 ,100 ,101 ,106 ,107 ,110 ,113 ,118 ,123 Not stated 1 2.2 112 * May add to more than 100%, because many interventions used multiple components.
Intervention Author, Year Intervention Content Sample Size (No.) Number (%) Screened Effect Size 95% CI Intervention Control Intervention Control Behavioral, usual-care controls Dickey & Petiti, 199296 * Health diary reminder 142 73 111 (78.2) 39 (53.4) 24.4 11.1, 37.7 Behavioral, active controls Ornstein et al, 1991111 Letter reminder 1,054 843 394 (37.4) 388 (46.0) −8.6 −13.1, −4.1 Lantz et al, 1995103 Letter, telephone reminders 236 238 45 (19.1) 14 (5.9) 13.2 7.4, 19.0 Somkin et al, 1997116 Letter reminder 1,188 1,188 230 (19.4) 108 (9.1) 10.4 7.6, 13.2 Binstock et al, 199786 Phone reminder 1,526 1,526 536 (35.1) 249 (16.3) 18.8 15.8, 21.8 Binstock et al, 199786 Letter reminder 1,526 1,526 403 (26.4) 249 (16.3) 10.1 7.2, 13.0 Cognitive theory-based, active controls, static delivery Kreuter & Strecher, 1996102 Educational letter 48 32 30 (62.5) 21 (65.6) −3.0 −24.4, 18.4 Kreuter & Strecher, 1996102 Educational letter 46 32 24 (52.2) 21 (65.6) −14.0 −35.9, 7.9 Rimer et al, 1999113 Educational letter 206 206 107 (52.0) 115 (56.0) −4.0 −13.6, 5.6 Cognitive theory-based, active controls, interactive Rimer et al, 1999113 Telephone counseling 206 206 132 (64.0) 115 (56.0) 8.0 −1.4, 17.4 Behavioral and cognitive (generic) Clementz et al, 199094 Letter reminder, educational pamphlet 102 76 21 (20.6) 23 (30.3) −9.7 −22.7, 3.3 Reding et al, 1997112 Letter reminder, telephone education 233 240 45 (19.2) 14 (5.8) 13.5 7.6, 19.4 Burack et al, 199885 Letter reminder, educational pamphlet 964 964 280 (29.0) 270 (28.0) 1.0 −3.0, 5.0 Sociologic Yancey et al, 199589 Culturally sensitive video 868 876 168 (19.4) 120 (13.7) 5.7 2.2, 9.2 Suarez et al, 199780 Lay health worker, culturally sensitive video Pre: 450 Pre: 473 Pre: 205 (45.6) Pre: 237 (50.1) −0.7 −9.8, 8.4 Post: 450 Post: 473 Post: 231 (51.3) Post: 268 (56.7) Sung et al, 199787 Lay health worker 163 158 96 (58.7) 98 (62.1) −3.4 −14.1, 7.3 Margolis et al, 199883 Lay health worker 501 466 352 (70.3) 293 (62.9) 7.4 1.5, 13.3 Navarro et al, 199884 Lay health worker 199 162 130 (65.3) 99 (61.1) 4.2 −5.8, 14.2 Gotay et al, 2000100 Lay health worker Pre: 318 Pre: 360 Pre: 188 (59.0) Pre: 277 (63.0) 7.0 −3.3, 17.3 Post: 318 Post: 360 Post: 213 (67.0) Post: 232 (64.0) Sociologic and cognitive, usual-care controls Dignan et al, 199688 Lay health worker 385 430 282 (73.2) 275 (64.0) 9.2 2.9, 15.5 Allen et al, 200178 Lay health worker, mass media, workshop 1,374 1,288 1,116 (81.2) 1,011 (78.5) 2.7 −0.3, 5.7 Sociologic, behavioral, and cognitive, usual-care controls Whitman et al, 1994122 Lay health worker, financial incentives, workshop Pre: 284 Pre: 189 Pre: 34 (12.0) Pre: 74 (39.0) 36.0 25.1, 46.9 Post: 283 Post: 175 Post: 74 (26.0) Post: 30 (17.0) Bird et al, 199882 Lay health worker, financial incentives, educational pamphlet Pre: 306 Pre: 339 Pre: 141 (46.1) Pre: 136 (40.1) 18.0 7.6, 28.4 Post: 346 Post: 372 Post: 228 (65.9) Post: 156 (41.9) Jenkins et al, 199981 Educational pamphlet, mass media, culturally sensitive video Pre: 451 Pre: 482 Pre: 245 (54.4) Pre: 210 (43.6) −0.1 −9.9, 8.3 Post: 454 Post: 422 Post: 217 (47.7) Post: 156 (37.0) CI = confidence interval.
* Based on the Papanicolaou smear being recommended or completed.
Intervention Author, Year Content Intervention Sample Size Number (%) Screened Effect Size 95% CI Intervention Control Intervention Control Behavioral, usual-care control McDonald et al, 1984107 * Computerized reminder NA NA (38.0) (23.0) 15.0 NA Tierney et al, 1986119 Computerized reminder 409 409 106 (26.0) 115 (28.0) −2.0 −8.1, 4.1 Cheney & Ramsdell, 198793 Flow sheet w/completion 132 132 75 (57.0)† 99 (75.0)† −18.0 −29.2, −6.8 Becker et al, 1989124 Chart reminder 146 123 9 (6.2) 7 (5.7) 0.5 −5.2, 6.1 Cowan et al, 199295 * Chart reminder 32 23 4 (12.5) 1 (4.3) 8.2 −5.9, 22.3 Dietrich et al, 199297 * Flow sheet w/completion NA NA (71.0) (61.0) 10.0 NA Cardozo et al, 199892 Flow sheet w/completion Pre: 82 Pre: 94 Pre: 35 (43.0) Pre: 92 (98.0) 44.0 28.2, 59.8 Post: 74 Post: 82 Post: 58 (79.0) Post: 74 (90.0) Schreiner et al, 1988115 * Chart reminder NA NA Pre: (25.0) Pre: (28.0) 6.0 NA Post: (34.0) Post: (31.0) Behavioral, active control Gonzalez et al, 198990 * Flow sheet w/completion Pre: 52 Pre: 47 Pre: 21 (40.0) Pre: 14 (30.0) 23.0 −3.4, 49.4 Post: 52 Post: 47 Post: 34 (65.0) Post: 15 (32.0) McPhee et al, 1989108 ‡ Computerized reminder 432 432 245 (56.7)† 199 (46.0)† 10.7 4.1, 17.3 Turner et al, 1989121 Computerized reminder 42 42 14 (33.1) 12 (27.5) 5.6 −14.0, 25.2 Turner et al, 1990120 * Patient carried prompt 94 151 28 (29.8) 30 (19.9) 10.0 −1.2, 21.2 Ornstein et al, 1991111 Computerized reminder 1,111 843 487 (43.8) 388 (46.0) −2.2 −6.7, 3.3 Litzelman et al, 1993104 Flow sheet w/completion 1,460 1,459 307 (21.0) 263 (18.0) 3.0 0.1, 5.9 Tape & Campbell, 1993118 * Computerized reminder 462 443 114 (24.7) 106 (23.9) 0.8 −4.8, 6.4 Binstock et al, 199786 Memo reminder 1,526 1,526 389 (25.5) 249 (16.3) 9.2 6.3, 12.1 Binstock et al, 199786 Computerized reminder 1,526 1,526 365 (23.9) 249 (16.3) 7.6 4.8, 10.4 Burack et al, 199885 Computerized reminder 960 964 278 (29.0) 270 (28.0) 1.0 −3.0, 5.0 Hillman et al, 1998101 * Financial incentives NA NA (42.7) (33.1) 9.6 NA Cognitive, usual-care controls Tierney et al, 1986119 Audit with feedback 409 409 131 (32.0) 115 (28.0) 4.0 −2.3, 10.3 McPhee et al, 1989108 ‡ Audit with feedback 432 432 233 (54.0)† 199 (46.0)† 8.0 1.4, 14.6 Dietrich et al, 199297 * Workshop, audit with feedback NA NA (63.0) (61.0) 2.0 NA Behavioral and cognitive, usual-care controls Tierney et al, 1986119 Audit with feedback, computerized reminder 409 409 90 (22.0) 115 (28.0) −6.0 −11.9, −0.1 Robie, 1988114 Workshop, chart reminder Pre: 13 Pre: 28 Pre: 4 (31.0) Pre: 6 (21.0) 18.0 −21.3, 57.3 Post: 20 Post: 32 Post: 10 (50.0) Post: 7 (22.0) Dietrich et al, 199297 * Workshop, audit with feedback, flow sheet w/completion NA NA (65.0) (61.0) 4.0 NA NA = not available.
* Based on the Papanicolaou smear being recommended or completed.
† Represents compliance scores.
‡ Three-year rates of Papanicolaou smear use converted to annual rates.
Intervention Author, Year Intervention Content Sample Size Number (%) Screened Effect Size 95% CI Intervention Control Intervention Control Behavioral, usual-care control Becker et al, 1989124 Chart reminder, reminder letter 114 123 14 (12.3) 7 (5.7) 6.6 −0.7, 13.9 McPhee et al, 1991109 * Computerized reminder, patient-carried prompt 710 710 366 (51.6)† 286 (40.3)† 11.3 6.1, 16.5 Behavioral, active controls Ornstein et al, 1991111 Computerized reminder, reminder letter 1,006 843 402 (40.0) 387 (46.0) −6.0 −10.5, −1.5 Somkin et al, 1997116 Reminder letter, reminder with completion 1,188 1,188 271 (22.8) 108 (9.1) 13.8 10.9, 16.7 Behavioral and cognitive, usual-care controls Gemson et al, 199599 ‡ Educational pamphlet, health diary, office reminder Pre: 38 Pre: 35 Pre: NA Pre: NA 6.0 NA Post: 71 Post: 53 Post: NA Post: NA Dietrich et al, 199898 ‡ Chart reminder, educational workshop, patient-carried prompt 1,059 918 585 (55.2) 572 (62.2) −7.0 −10.6, −3.4 Melnikow et al, 2000110 Computerized reminder, reminder with completion, educational workshop, office reminder Pre: 295 Pre: 310 Pre: 136 (46.0) Pre: 205 (66.0) 3.0 −8.0, 14.0 Post: 295 Post: 310 Post: 139 (47.0) Post: 198 (64.0) Behavioral and cognitive, active controls Turner et al, 1989121 Computerized reminder, educational pamphlet 42 42 17 (40.0) 12 (27.5) 12.5 −7.5, 32.5 Burack et al, 199885 Letter reminder, educational pamphlet, computerized reminder 960 964 307 (32.0) 270 (28.0) 4.0 −0.1, 8.1 Manfredi et al, 1998106 Reminder with completion, audit with feedback, patient-carried prompt, educational workshop 821 647 429 (52.3) 269 (41.6) 10.0 4.9, 15.1 Behavioral, cognitive (generic), and sociologic Williams et al, 1998123 Reminder letter, educational pamphlet, computerized reminder, educational workshop 725 725 159 (21.9) 183 (25.2) −3.3 −7.7, 1.1 Behavioral, theory-based cognitive and sociologic Paskett et al, 199979 Reminder letter, health diary, chart reminders, educational mass media, educational pamphlet, educational counseling, lay health worker, educational workshop Pre: 125 Pre: 123 Pre: 91 (73.0) Pre: 82 (67.0) 21.0 6.0, 36.0 Post: 168 Post: 134 Post: 146 (87.0) Post: 80 (60.0) NA = not available.
* Three-year rates of Papanicolaou smear use converted to annual rates of Papanicolaou smear use.
† Represents compliance scores.
‡ Based on Papanicolaou being recommended or completed.
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