Can personal health record booklets improve cancer screening behaviours?

Background: Despite the widespread use of written health education materials as interventions, relatively few studies have adequately evaluated the effectiveness of such materials on changing healthcare behaviors in the general population. Setting/ Participants: The study consisted of ten matched pairs of small rural towns in New South Wales, Australia, with a total combined population of approximately 25,000 in both the intervention and control group towns. A randomized controlled trial was used. Intervention: Personal Health Record Booklets (PHRBs) that include the latest evidence-based recommendations for reducing risk of cancer and cardiovascular disease were developed using leading behavioral change theories to maximize effectiveness. The booklets included an explanatory letter, a gender-specific Better Health Booklet, and a gender-specific Better Health Diary. Following a media campaign, the PHRBs were mailed to all residents aged 20 to 60 years (about 12,600 people) in the ten intervention towns. Family practitioners in the intervention towns were recruited to support and encourage people to use the PHRBs. Main Outcome Measures: Health Insurance Commission data for Papanicolaou (Pap) tests, mammograms, and skin operations were obtained for 5 years before the intervention, and 3 months and 1 year after the intervention. Results: No significant increases in the rates of Pap tests, mammograms, and skin operations were detected in either short- or long-term follow-ups. Conclusions: While PHRBs may represent an inexpensive, easy-to-produce, and time-efficient method of communicating information to the general population, it appears unlikely that any significant behavioral change will result unless such materials are targeted toward high-risk groups or constitute the first intervention for a particular risk factor.