PubMed · 10797726
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2000. Keeping in touch.. https://doi.org/10.1097/00152193-200030040-00041
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OBJECTIVE: To determine whether health insurance expansions via a Medicare buy-in might plausibly increase mammography screening rates among women aged 50-64. DATA SOURCES: Two waves of the Health and Retirement Study (HRS) (1994, 1996). STUDY DESIGN: A longitudinal study with most explanatory variables measured at the second wave of HRS (1994); receipt of mammography, number of physician visits, and breast self exam (BSE) were measured at the third wave (1996). DATA EXTRACTION: Our sample included women aged 50-62 in 1994 who answered the second and third HRS interview (n = 4,583). PRINCIPAL FINDINGS: From 1994 to 1996, 72.7 percent of women received a mammogram. Being insured increased mammography in both unadjusted and adjusted analyses. A simulation of universal insurance coverage in this age group increased mammography rates only to 75-79 percent from the observed 72.7 percent. When we accounted for potential endogeneity of physician visits and BSE to mammography, physician visits remained a strong predictor of mammography but BSE did not. CONCLUSION: Even in the presence of universal coverage and very optimistic scenarios regarding the effect of insurance on mammography for newly insured women, mammography rates would only increase a small amount and gaps in screening would remain. Thus, a Medicare buy-in could be expected to have a small impact on mammography screening rates.
In this study, we used the topic of breast self-examination (BSE) to illustrate how content analysis of promotional texts (already in existence, in the process of being created, or both) can provide supplementary data to that derived from audience analysis. Specifically, we used content analysis to isolate messages in BSE pamphlets that are consistent with the variables of severity, susceptibility, response efficacy, and self-efficacy, identified by existing fear appeal research and supported by other persuasion research as critical to the construction of effective health promotion messages. We then used statistical analyses to describe the relation among these 4 message variables. Our findings suggested that BSE pamphlets contain an unbalanced proportion of threat to efficacy arguments. Additionally, the efficacy messages were substantively weak. We contrasted these messages against the relatively strong mammography arguments contained in these pamphlets. We then provided recommendations for formulating stronger persuasive arguments in BSE promotional materials.
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