Journal of Community Health Nursing, 28:130143, 2011

Copyright Taylor & Francis Group, LLC

ISSN: 0737-0016 print / 1532-7655 online
DOI: 10.1080/07370016.2011.589230

Evaluation of an Intervention Designed to Recruit Canadian

Women to Mammography Screening
Kim Hanson, Phyllis Montgomery, and Debra Bakker
School of Nursing, Laurentian University, Sudbury, Ontario, Canada

Michael Conlon
Sudbury Regional Hospital, Sudbury, Ontario, Canada

Mammography screenings have the potential to reduce mortality; unfortunately, participation rates
remain below federally established targets. To increase screening, the Ontario Breast Screening
Program (OBSP) implemented a mammography recruitment intervention that involved a locally
designed postcard. The first phase of this descriptive study involved the distribution of a questionnaire to determine how attendees became aware of the OBSP. Semistructured telephone interviews
were conducted in the studys second phase to describe breast screening attendees perceptions of the
postcard campaign. Although the participants positively appraised the postcard initiative, it played a
minor role in comparison to typical OBSP recruitment methods.

Breast cancer is the most common cancer among women in both Canada and the United States,
accounting for approximately 28% of all cancer cases in both countries (Canadian Cancer
Society, 2010a ; Jamal, Siegal, Xu, & Ward, 2010). Research indicates that regular mammography screenings have the potential to reduce breast cancer mortality rates as much as 34% for
women between the ages of 50 and 74 (Taber et al., 1995). The Ontario Breast Screening Program
(OBSP) is a Canadian program that is publically funded through the Ontario Ministry of Health
and Long Term Care (Cancer Care Ontario, 2010). The OBSP has provided free, comprehensive, and organized mammography screening services to eligible women (50 years of age and
older) living in Ontario since 1990. The screening specialists include nurse examiners, technologists, radiologists, and physicians. Currently, services are provided through 153 screening centers
across the province of Ontario (Cancer Care Ontario, 2010). To achieve their goal of reducing
breast cancer mortality rates, organized breast screening programs in Ontario must screen at
least 70% of the eligible population, a target based on peer-reviewed literature (Wadden, 2005).
Current OBSP participation rates, however, remain well below the specified target. According
to Cancer Care Ontario (2006), the participation in mammography screening ranges from
18.5 to 51.5%.
Address correspondence to Phyllis Montgomery, School of Nursing, Laurentian University, Ramsey Lake Road,
Sudbury, Ontario, Canada P3E 2C6. E-mail: pmontgomery@laurentian.ca

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BACKGROUND
There is much literature about factors influencing womens decision to participate in mammography screening. In a recent integrative review (Hanson, Montgomery, Bakker & Conlon, 2009),
Canadian women reported the following barriers to mammography screening: concerns of pain,
radiation, or embarrassment, being a member of an ethnic minority, low socio-economic status,
perceived inconvenience, and lack of physician referral. Reported facilitators for participation
included: recommendation from a health care provider; support from a womans social network;
participation in other screening programs; and perception of risk. To promote womens participation in mammography screening, a variety of recruitment interventions have been implemented.
Rimer, Meissner, Breen, Legler, and Coyne (2001) proposed a framework that grouped interventions into seven categories ranging from individual- to social network-directed interventions. For
example, an individual level intervention is a women receiving printed material. At a social network level, peer leaders or lay health advisors are involved in relaying desired health promotion
messages.
In addition, research has been conducted to evaluate various strategies for mammography
recruitment. Most evidence demonstrates that promotional print items used alone or in combination with other recruitment strategies yield an increase in mammography screening rates
(Champion et al., 2003; Champion et al., 2007; Defrank et al., 2009; Kagawa-Singer, Park
Tanjasiri, Valdez, Yu, & Foo, 2009; Michielutte et al, 2005; Page, Morrell, Chiu, Taylor, &
Tewson, 2006; Rakowski et al., 2003; Saywell, Champion, Skinner, Menon, & Daggy, 2004;
Sohl & Moyer, 2007; Van Harrison et al., 2003). Only a few studies have reported no increase
in mammography screening as a result of printed promotional items (Barr et al., 2001; Bodurtha
et al., 2009; Simon, Gimotty, Moncrease, Dews, & Burack, 2001; Skinner et al., 2007).
With regards to social networking interventions, results are mixed. Networking interventions
with minority groups of women were often associated with enhanced mammography participation (Burhansstipanov, Dignan, Wound, Tenney & Vigil, 2000; Earp et al., 2002; Fernandez et al.,
2009; Fowler, Rodney, Roberts, & Broadus, 2005; Han, Lee, Kim, & Kim, 2009; Larkey, 2006;
Paskett et al., 2006; Yu et al., 2002). In comparison, no statistically significant effect was noted
in other studies involving minority subgroups of women (Allen, Stoddard, Mays, & Sorensen,
2001; Anderson et al., 2000; Fernandez-Esquer, Espinoza, Torres, Ramirez, & McAlister, 2003;
Hiatt et al., 2008; Park Tanjasiri, Sablan-Santos, Merrill, Quitugua, & Kuratani, 2008; Tejeda,
Thompson, Coronado, Heagerty, & Martin, 2009).
Many of the aforementioned studies involved American women. Only one study used a sample
of Canadian women (Heyding, Cheung, Mocarski, Moineddin, & Hwang, 2005). This nonexperimental study implemented an access enhancing intervention by inviting women to a luncheon
followed by a mammography screening. The increase in the number of women screened was
attributed to women becoming familiar with the agencys staff and its flexible group scheduling.
Regardless of a studys setting, none of the reviewed literature incorporated womens narrative
evaluation of a particular recruitment approach.
The purpose of this study was to evaluate a mammography recruitment intervention undertaken by a northern OBSP site. The intervention combined individual and social network
strategies. In collaboration with a group of women, staff at the OBSP site created a promotional
postcard (Figure 1) that was distributed to eligible women using a variety of venues, including
the involvement of trained lay health advisors, as well as current OBPS attendees. Postcards were

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FIGURE 1 Postcard Used for Recruitment (color figure available

online).

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also placed in prominent locations throughout the community, such as in physicians offices. The
research questions were:
1. How did breast screening attendees become aware of the OBSP?
2. How did breast screening attendees perceive the postcard recruitment intervention?

METHODS
The study used a descriptive design. The OBSP staff requested that the study be conducted in two
sequential phases to avoid compromising the identities or personal health information of breast
screening attendees. Therefore, the samples of each phase involved different women. Ethical
approval was obtained from respective agencies.
Phase I: How Did Breast Screening Attendees Become Aware of the OBSP?
All women who were eligible for screening (residents of Ontario; ages 5074 years) and underwent a mammogram following the implementation of the postcard campaign were invited to
participate in this phase of the study. A one-page self-report questionnaire entitled Reasons for
Coming to Breast Screening (Conlon et al., 2007) was utilized, as it was familiar to the screening facility. The instrument has reported face validity, but its reliability remains unknown. For
this study, the original questionnaire was modified to include a question to ascertain if this was
the womens initial mammogram and the postcard campaign was added to the list of potential
reasons for attending mammography screening. The questionnaire was distributed to all eligible
women attending a screening appointment by an OBSP nurse who was trained in the data collection process. To maintain anonymity and confidentiality, participants were instructed to not
include any personal identifiers such as names or contact information on the questionnaire. After
completing the questionnaire, participants placed the form into a sealed box located in the waiting area of the agency. Descriptive statistics were used to determine the reasons for womens
awareness of the OBSP program and their most influential reasons for attendance.
Phase II: How Did Breast Screening Attendees Perceive the Postcard
Recruitment Intervention?
Purposive sampling was used to recruit English-speaking women aged 50 years or older who
were aware of the postcard campaign. An OBSP nurse identified eligible women, provided
them with an information package, and asked their permission to be contacted by phone by
the researchers. Data about attendees perceptions of the postcard campaign and their screening experiences were collected during semistructured, audio-recorded telephone interviews.
Transcribed data were analyzed using thematic content analysis (Burnard, 1991). A descriptive,
rather than an interpretative, approach was taken to identify representative patterns in relation to
an existing conceptual frame (Hsieh & Shannon, 2005), in this case, the postcard. Credibility in
descriptive research refers to the degree to which findings are faithful to participants views and
behaviors (Sandelowski & Barroso, 2002). To ensure transparency of coding and categorizing,
identified categories were openly and regularly discussed among the research team.

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FINDINGS
Phase I
One hundred and forty women completed the anonymous self-report questionnaires. Sixteen
participants (11%) indicated that they were receiving their first mammogram, 121 (86%) were
repeat screeners, and three women did not indicate their screening status. Table 1 presents how
attendees became aware of the OBSP. Because multiple responses were possible for each participant, percentages of responses refers to the responses for each item in relation to all reported
responses (N = 322) and percentage of cases is the response for each item in relation to the
number of participants (N = 140).
Physician recommendation was identified most frequently as a way of hearing about the
OBSP. Encouragement from a friend, relative, or coworker was identified as the next most
common choice, followed by television advertising. The postcard was identified as a source of
awareness by only three participants, and it ranked 16 out of 20 available choices. This ranking is shared with the item, My doctor sent me a letter about it. The two items to obtain a
lower ranking than the postcard were at a presentation or meeting, and I saw the OBSP van
or shuttle.
The questionnaire also asked women to identify the reason that most convinced them to attend
screening. This question was answered by 130 (93%) out of 140 participants (Table 2). Physician

TABLE 1
How Women Became Aware of the Ontario Breast Screening Program (OBSP)

Questionnaire Items
My doctor suggested I come
From a friend, relative, or coworker
On TV
Some other way
From a pamphlet or brochure
From a special display about the OBSP
In a magazine
I received a notice in my paycheck or mailbox
In the newspaper
On the radio
From a poster, billboard, or banner
My doctor made the appointment
From a presentation/display
From another hospital or clinic
In a newsletter or bulletin
The postcard
My doctor sent me a letter about it
At a presentation or meeting
I saw the OBSP van or shuttle
Im not sure

Frequency of
Responses

% of Responses
(N = 322)

% of Cases
(N = 140)

87
50
33
27
24
18
17
13
13
12
9
9
9
8
8
3
3
2
2
2

27.0
15.5
10.2
8.4
7.5
5.6
5.3
4.0
4.0
3.7
2.8
2.8
2.8
2.5
2.5
0.9
0.9
0.6
0.6
0.6

65.9
37.9
25.0
19.3
18.2
13.6
12.9
9.8
9.8
9.1
6.8
6.8
6.8
6.1
6.1
2.3
2.3
1.5
1.5
1.5

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TABLE 2
The Most Influential Reason for Attending Breast Screening
Cases (N = 30)
Questionnaire Items
My doctor suggested I come
From a friend, relative or coworker
From a pamphlet or brochure
Some other way
I received a notice in my paycheck or mailbox
My doctor made the appointment
On tv
From a Presentation/Display
From another hospital or clinic
Im not sure
The Postcard
My doctor sent me a letter about it
At a presentation or meeting
From a special display about the OBSP
In the newspaper
On the radio
In a magazine
In a newsletter or bulletin
From a poster, billboard or banner
I saw the OBSP van or shuttle

Number

Percentage

66
30
7
6
5
3
3
3
2
1
1
0
0
0
0
0
0
0
0
0

50.8%
23.1%
5.4%
4.6%
3.8%
2.3%
2.3%
2.3%
1.5%
0.8%
0.8%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%

recommendation was identified most frequently as the most influential reason for attending breast
screening, followed by encouragement from a friend, relative, or coworker. The third most influential reason was a pamphlet or brochure. The postcard was identified only once and ranked 11
out of 20 possible choices. Items with a lower ranking than the postcard were not identified as a
most influential reason by any of the participants.
Phase II
Eighteen women participated in telephone interviews. Fifteen women (83%) were aged 5059
years. Three other women (17%) were older than 60 years of age. Fourteen women (78%) identified themselves as married. All were Canadian citizens. Four described themselves as French
Canadian and three identified a European background. The majority of women (89%) lived
within 100 km of the screening agency and only two women (11%) reported traveling more
than 100 kilometers to access screening. Of the 18 participants, 14 women (78%) had a previous
mammogram.
Participant views of the postcard as a recruitment strategy are presented in three themes.
The first theme, labeled as awareness of the postcard campaign, describes how women
received a recruitment postcard. The second theme, appraisal of the postcard, provides information on how the postcard was perceived negatively or positively. The final theme, resultant actions, describes how the postcard influenced mammography participation. Each theme

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HANSON ET AL.

reflects womens evaluation of the postcard from the way they talked about it during the
interviews.
Awareness of the postcard campaign. Participants became aware of the recruitment
postcard through both active and passive distribution sources. Approximately half (51%) received
a card actively through their social support networks of family, friends, coworkers, and other service providers (such as hair dressers). This is not surprising, as part of the campaign involved
engaging key community volunteers and current breast screening attendees to distribute the card.
The postcard campaign also employed passive distribution techniques, such as leaving postcards
in physicians offices and hair salons, or delivering postcards through the mail. The remaining women indicated that one of these passive distribution techniques was the source of their
postcards. Through this campaign, awareness via multiple routes was possible and appeared to
heighten awareness. In one womans view, With the card and the write up in the paper, that
together, that was a good idea, rather than just the card. It was because it was in more than one
media that it was more pronounced, more visible.
Appraisal of the postcard. All participants had views about the postcards pictorial image.
Overall, it was evaluated positively, especially in terms of the images eye-catching nature and
its meaningfulness. The inclusion of a real family of women with a genuine breast screening
story was appealing and made it stand out from all of the others. Although most participants
were not familiar with the women depicted on the card, a couple of them recognized one woman,
who was a local public figure. Her involvement in the campaign was viewed as an asset to the
promotion of breast screening and it emphasized the importance of this health practice. The
familys involvement in the campaign and their modeling of mammography participation was
reassuring:
I thought they were pretty brave just going for the test to begin with. What they went through, then
to be showing us that its alright. I dont know, just kind of again the identifying thing. I can, if they
can. If you do it so can I.

The photographic image of the women was evaluated as tasteful, attractive, natural,
and unusual, but not offensive. The implied nudity grabbed their attention. Several of
the participants specifically commented on the facial expressions of the women in the postcard. Their smiles were interpreted as inviting and warm, rather than inducing a sense of
fear. For most women, another eye-catching feature of the image was its sepia coloring.
The image, rather than the text on the card, was what women most often recalled. Few
women were able to elaborate about the postcards textual information, most stated they didnt
remember it. For the few who could recall the text, it was evaluated as easy to read and
straightforward.
The meaning attributed to the image was influenced by two issues: study participants general
beliefs about the risk of breast cancer and their experiences as either new or repeat screeners. The
inclusion of young and older women on the postcard suggested two perceptions. The first belief
was that all women, regardless of age, were at risk for breast cancer. The second perception was
that all women, regardless of age, should be screened. For example, Well, its for young and
older and you never know when. . . . Well, you can get breast cancer no matter what age you
are . . . that anyone can get it. It can go from generation to generation.

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Breast screening was viewed as normal, natural, and for your own good. Screening was
associated with living a longer life, especially in circumstances where cancer was detected. The
importance of engaging in breast screening was particularly emphasized by women who had
their own family histories of cancer. Its not if youre going to get it, but its more like when we
are going to get it.
Resultant actions. In this sample, there were two groups of screeners based on screening
history, initial (n = 4) and repeat (n = 14) screeners. The postcard seemed to serve two different
purposes. For initial screeners, the card was instrumental in moving these women from apprehension about the procedure to actively participating in mammography screening. In three of the
four cases, the combination of the card with support from family or friends motivated them to
attend their initial mammography screening. For example,
Well, if I had not got it [the card], I probably would not have gone for a mammogram. . . . Well, like
I said, I have just been through many, many invasive tests over the past few years and was not in the
mood to have anything else done. So, had I not got the card from my sister, I probably would never
have gone for a mammogram.

Fears associated with pain, receiving a breast cancer diagnosis, and/or embarrassment were the
predominant barriers expressed by initial screeners. These concerns were often a result of horror
stories the women had heard from others, but these fears were resolved following their screening
experience.
All of the four initial screeners described a positive screening experience, which helped to
reinforce their decision to attend mammography screening. The women appreciated that the
center was tailored specifically to women and that the relaxed, family atmosphere and
professional staff placed them at ease and helped to alleviate their concerns.
For repeat screeners, the postcard served as a reminder, rather than a decision influencer to
participate in screening. Receiving the card reminded them of the need to schedule their regular
appointment. For example, a women reported, You bring the card home and you put it on your
fridge. . . . Its a reminder if you put it somewhere that is visible. Its visibility precipitated
awareness of breast health by opening dialogue about breast screening for family, if not for
yourself.
Like the initial screeners, the repeat screeners also described their recent visit to the
mammography facility as being positive. Having positive past screening experiences was
significant in decisions to participate in future mammography screenings. In comparison to
their current experience, five repeat screeners described previous screening experiences at
other agencies as rough, less friendly or informative, uncomfortable and painful.
For a couple of repeat screeners, their negative previous experiences resulted in an avoidance of screening for a period of time. For these women, their current appointment was
made following encouragement from their physicians and was their first mammogram in
approximately 1020 years. Although the postcard did not actively persuade these women to
reparticipate, these participants reported that the card reinforced their physicians recommendation and the positive screening experience further reinforced the decision to have future
mammograms.

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DISCUSSION
The findings of this study indicate that, in comparison to various strategies of breast health and
screening promotion, the postcard campaign was not a major source of persuasion for women living in the region of this OBSP site to attend breast screening. Rather, the major influential reasons
for attendance remained unchanged from data collected previously at this OBSP site (Conlon
et al., 2007). Physician recommendation remained the major source of awareness and influence,
followed by encouragement from peers and television advertising. For those women who had
indicated an awareness of the postcard campaign, however, their behavior was influenced, in
part, by their receipt of the card. Initial screeners who had participated in the interviews indicated that they were persuaded to have their first mammograms; repeat screeners were reminded
to book their regular screening appointments.
According to Pender, Murdaugh, and Parsons (2006), the decision to engage in health
promotion behaviors is influenced by various interpersonal, cognitive, and situational factors.
Interpersonal facilitators were used in the postcard campaign to overcome the potential existence
of cognitive barriers. The postcard recruitment strategy included the use of OBSP attendees and
community volunteers to identify and encourage eligible women to participate in mammography screening. For the women who stated that they were persuaded to have a mammogram due
to the postcard, all of them indicated that they made their appointments after they received the
card from a friend or family member. Although these women reported being aware of their eligibility for mammography screening previously, they had avoided it due to personal concerns
about the procedure. Fear of pain and embarrassment previously has been identified as a barrier to mammography screening for Canadian women (Bakker, Lightfoot, Steggles, & Jackson,
1998; Bottorff et al., 1998; Degrasse, OConnor, Perrault, Aitken, & Joanisse, 1996; OConnor &
Perrault, 1995). For initial screeners, it was peer support, as well as the positive screening experience encountered, that helped to alleviate their apprehensions. Peer support has been shown to
be an effective means of promoting breast screening behaviors (Yabroff & Mandelblatt, 1999).
The promotional postcards were actively distributed using a womans social network, but they
were also passively left in prominent locations, such as physicians offices and hair salons. The
presence of the postcard in a womans environment has the potential to be a situational facilitator
if it is noticed by the intended target audience and if mammography participation is encouraged.
Study participants found the card aesthetically pleasing and they were intrigued by its content. Various studies have determined that images have the ability to instill a sense of curiosity,
facilitating the selection and reading of text (Knobloch, Hastall, Zillmann, & Callison, 2003;
Zillmann, Gibson, & Sargent, 1999; Zillmann, Knobloch, & Yu, 2001). Although most women
in our sample indicated that the postcards text was easy to read and understand, few of them
could remember the information provided. Weeks may have elapsed between the women receiving the card and their study participation, and this may have accounted for their inability to recall
any of the printed material. This time lapse, however, did not interfere with their ability to recall
the picture. It was the photographic image of the women displaying modest nudity across multiple generations that made a lasting impression. Still images can have a powerful influence on
perceptions and information recall. Zillmann et al. (1999) studied the influence of photographs in
news magazine reports. They determined that bias was detected in the direction exemplified by
the photographs. This biasing effect occurred only after some time had passed and was not noted
immediately after exposure to both text and image. The theory of dual coding was offered as

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an explanation. Dual coding suggests that although there is an interconnection between text and
images, they are stored independently in the brain. Over time, perceptions of the phenomenon
are dominated by images instead of text (Gibson & Zillmann, 2000).
The printed text on the postcard briefly described the familys experience with their grandmothers early detection of breast cancer and that due to breast screening she was alive and able
to share life with her family. This was not congruent with several study participants interpreted
message. Rather, they recalled the image of three generations of women and for them the postcards message was that breast cancer does not discriminate and women of all ages should go
for mammography. Although all women are susceptible to breast cancer, most cases occur in
women over the age of 50 (Canadian Cancer Society, 2010b). Risk increases sharply with age
and according to McCance and Huether (2002), a womens breast cancer risk is low at age 25
(1/19,608) and increases to approximately one in 50 by 50 years of age and one in14 by 70 years
old. Evidence also suggests that mammography screening in younger women is less effective due
to the dense breast tissue found in this population (Ontario Ministry of Health and Long Term
Care, 2007). Currently in the province of Ontario, publically funded mammography screenings
does not begin until a woman turns 50 years of age. As a result, women of all ages are not eligible
for routine mammograms in this publically funded cancer prevention program. The use of a real
family and nudity was effective at attracting the attention of women in the community, but future
mammography recruitment efforts should be cautious about the use of younger women in their
promotions. By using women in the targeted age group, confusion regarding who is eligible for
routine mammography screenings may be avoided.

IMPLICATIONS FOR ADMINISTRATION, PRACTICE AND RESEARCH

In this study, the postcard recruitment campaign was found to be well received by some members
of the target population, and it may have played a minor role to persuade some women to attend
breast screening for the first time. However, the use of a womans support network appeared
to be an effective strategy for identifying women who were eligible for screening, but reluctant
to have a mammogram. The encouragement these women received from their peers did play a
role in overcoming screening apprehensions. The postcards influence was not restricted to initial
screeners. It may not have persuaded repeat attendees to participate in screening, but it was found
to serve as a reminder for them to make their screening appointments.
Improvements to future postcard campaigns are possible. Recruitment efforts should be cautious about the use of young women to promote routine mammography screening. Pictures relay
powerful and lasting messages, so the concreteness of an image is essential in health promotion
strategies. Because a physicians recommendation remains the most influential means of promotion, future campaigns may also benefit from using health care providers to actively distribute
the postcards. Like the peer recruiters, primary health care providers could identify women who
are eligible but who have not yet utilized the service. The cards could then serve to instigate a
discussion about mammography screening and existent cognitive barriers could be identified and
addressed.
Health promoters, in general, should be aware that the images they use to promote various
health behaviors can influence perceptions and information recall. Nurses are often involved in
the development of health promotion strategies. Unfortunately, little consideration is given to

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HANSON ET AL.

advertising principles in health programs such as nursing. This lack of advertising awareness
and the subsequent use of ineffective images can be detrimental, leading to wasted health care
resources and the delivery of distorted health messages. Because misperceptions are possible,
nurses should also ensure that accurate health messages are being received during individual
moments of assessment and health teaching.
Future research opportunities exist. Because misperceptions regarding health promotions are
possible, evaluation research is recommended to ensure that accurate and effective health initiatives are being implemented and intended outcomes are being reached. This study assessed
the postcard recruitment campaign using women who chose to participate in mammography
screening. This may have accounted for the high degree of positive responses heard during the
interviews. Investigating the perceptions of those who received the card but chose not to have a
mammogram may have yielded more suggestions for improvement to the campaign; therefore,
further research with this population is recommended to assist in recruiting non-attendees.
A number of other limitations are associated with this research project. Due to organizational
demands and scheduling, it was not possible to implement a descriptive pre- and postsurvey
design. Although not ideal, the researchers attempted to overcome this deficit by using previous
research as a baseline for comparison of reasons for attending breast screening (Conlon et al.,
2007). Although the entire northeast region of the province was targeted by the postcard campaign, only one northern mammography facility was accessed and thereby limited the size of the
sample. A convenience sample is not representative of the population for which it is attempting
to represent (Schwarcz, Spindler, Scheer, Valleroy, & Lansky, 2007). Due to the use of convenience sampling, it is not possible to generalize the findings beyond the study sample. Finally,
other breast screening health promotions were occurring concurrently with the promotional card
initiative. This is evidenced by the varied responses obtained from the questionnaire. It is not
possible to determine if these promotions had an impact on awareness and response to the post
card campaign.

CONCLUSION
In conclusion, breast cancer is the most common cancer in women living in Canada and the
United States outside of skin malignancies. Mammography screening has the potential to reduce
mortality, yet participation rates remain below provincially established targets. To overcome
potential barriers to screening, a mammography recruitment intervention was developed and
launched by one OBSP site. This study evaluated the new recruitment strategy in relation to other
promotions and womens perceptions of the campaign. Although the postcard was not a major
source of promotion, it was meaningful to a subsample of women in the targeted population.
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