Can personal health record booklets improve cancer screening behaviours?

Background: Despite the widespread use of written health education materials as interventions, relatively few studies had adequately evaluated the effectiveness of such materials at changing health behaviors among the general population. Design: Randomized, controlled trial. Setting / Participants: Ten matched pairs of small, rural towns in New South Wales, Australia, with total populations of approximately 25,000 in each group. Intervention: The Personal Health Record Booklets (PHRBs) included the latest, evidencebased recommendations for reducing risk of cancer and cardiovascular disease and were developed using leading behavior change theories, to maximize their likely impact. They included an explanatory letter, a gender-specific Better Health Booklet and a gender-specific Better Health Diary. They were personally mailed to everyone aged 20 to 60 years (around 12,600 people) in the 10 intervention towns following a media campaign. 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 Pap tests, mammograms and skin operations were obtained for 5 years pre-intervention and 1 year post-intervention. Results: No significant increases in the rates of these procedures 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 towards high-risk groups or represent the first intervention for a particular risk factor.