Adherence to clinical preventive services guidelines: Population-based online randomized trial

Abstract

The Patient Protection and Affordable Care Act (ACA) addresses use of clinical preventive services relative to evidence-based guidelines by mandating that most health insurance plans provide coverage without cost-sharing for services that receive an A or B rating. However, knowledge about and positive attitudes towards guidelines are extremely low. This study was a population-based randomized experiment to examine beliefs about and intentions to adhere to screening guidelines for the Prostate Specific Antigen (PSA) and Pap tests. The study had two objectives: (1) test reactions to and understanding of guidelines, and (2) experimentally compare receptivity to messages to promote PSA and Pap test recommendations. We first surveyed a population-based sample of (1) US adults age 18 and over, (2) subsample of women aged 65 or younger, (3) subsample of men aged 40 or older. A sample of 2923 completed an initial questionnaire. Next a subset of participants meeting eligibility criteria were recruited from the population-based sample into a message testing experiment: (1) women aged 65 or younger, (2) and men aged 40 or older. Participants meeting these eligibility requirements were randomized to gain, loss, or balanced PSA (men) or Pap test (women) message stimulus conditions and followed for 8 weeks. Data were collected through the GfK Custom Research panel. A total of 2401 were eligible, 2321 completed the baseline, and 1730 completed follow up. Mixed effect regression models revealed that higher receptivity to messages was associated with greater intentions to seek cancer information and to speak to a Doctor about PSA and Pap tests. The loss frame was associated with higher intentions to speak to friends and family about PSA and Pap tests. Finally, perceived importance and personal understanding of guidelines predicted intentions to seek more information about them. This study contributes to evidence on how best to inform and engage consumers regarding preventive services.

Keywords: Cervical cancer screening; Clinical guidelines; Framing; Message testing; Preventive Services Taskforce; Prostate cancer screening.