The goal of this project is to evaluate the effectiveness and acceptability of a computer-based telecommunications system for increasing of regular screening mammography among women ages 50-74. The Telephone-Linked-Communications for Mammography Screening (TLC-M) is designed to educate, advise and motivate women to have regular screening mammograms. There will be two versions of the TLC-M: one for women who are coming due for their annual screening mammogram (""""""""pre-due"""""""" women) and a second version for women who missed their annual mammogram and who are """"""""past-due"""""""" (""""""""past-due"""""""" women). The TLC technology supporting TLC-M has been successfully used to positively affect patient behavior in medication compliance, diet and exercise. It uses real human voice to speak over the telephone; the users communicate by using the touch tone keypad on their telephones. TLC-M will consist of up to three automated telephone conversations. The content of these conversations is based on the Transtheoretical Model in which a women's readiness to obtain routine screening mammograms is assessed. Depending upon the women's intention, barriers for having mammography are identified and addressed. In the proposed project, the investigators will (1) modify a current version of TLC-M, (2) pretest and modify the system accordingly, and (3) conduct two linked randomized controlled trials of the effectiveness of TLC-M in increasing mammography rates in """"""""pre-due"""""""" and """"""""past-due"""""""" women. Eligible women will be ages 50-74 and will have received a screening mammogram six months prior to entering the study. The researchers will recruit 1,050 participants over 12 months from a general medical practice, using the computer system of an affiliated radiology department to screen for potentially eligible women, followed by a telephone and office interviews to determine final eligibility and to collect baseline data. One month prior to their due date for annual screening mammography, these women will receive a reminder letter to schedule a mammogram. In addition, a random sample of 150 of them will use TLC-M. All participants in this 'pre-due"""""""" intervention will be evaluated 4 months after their intervention to determine whether they obtained a mammogram. Women who received the letter only and who did not obtain a mammogram during the observation period (estimated to be 360 [40 percent of 900]} will enter a """"""""past-due"""""""" reminder letter or to use TLC-M. Four months after the interventions, participants will be evaluated to determine whether they had a mammogram. Mammography rates will be determined and compared using logistic regression to control for potential demographic, medical and behavioral confounders. TLC-M users in both studies will be queried regarding their satisfaction with TLC-M.
