Abstract
BackgroundCancer Care Ontario’s Screening Activity Report (SAR) is an online audit and feedback tool designed to help primary care physicians in Ontario, Canada, identify patients who are overdue for cancer screening or have abnormal results requiring follow-up. Use of the SAR is associated with increased screening rates. To encourage SAR use, Cancer Care Ontario sends monthly emails to registered primary care physicians announcing that updated data are available. However, analytics reveal that 50% of email recipients do not open the email and less than 7% click the embedded link to log in to their report.ObjectiveThe goal of the study is to determine whether rewritten emails result in increased log-ins. This manuscript describes how different user- and theory-informed messages intended to improve the impact of the monthly emails will be experimentally tested and how a process evaluation will explore why and how any effects observed were (or were not) achieved.MethodsA user-centered approach was used to rewrite the content of the monthly email, including messages operationalizing 3 behavior change techniques: anticipated regret, material incentive (behavior), and problem solving. A pragmatic, 2x2x2 factorial experiment within a multiphase optimization strategy will test the redesigned emails with an embedded qualitative process evaluation to understand how and why the emails may or may not have worked. Trial outcomes will be ascertained using routinely collected administrative data. Physicians will be recruited for semistructured interviews using convenience and snowball sampling.ResultsAs of April 2017, 5576 primary care physicians across the province of Ontario, Canada, had voluntarily registered for the SAR, and in so doing, signed up to receive the monthly email updates. From May to August 2017 participants received the redesigned monthly emails with content specific to their allocated experimental condition prompting use of the SAR. We have not yet begun analyses.ConclusionsThis study will inform how to communicate effectively with primary care providers by email and identify which behavior change techniques tested are most effective at encouraging engagement with an audit and feedback report.Trial RegistrationClinicalTrials.gov NCT03124316; https://clinicaltrials.gov/ct2/show/NCT03124316 (Archived by WebCite at http://www.webcitation.org/6w2MqDWGu)
Highlights
Health care provider behavior is an important determinant of patients’ use of screening services [1,2,3,4,5]
This study will inform how to communicate effectively with primary care providers by email and identify which behavior change techniques tested are most effective at encouraging engagement with an audit and feedback report
We describe the design of a pragmatic, factorial randomized experiment using the Multiphase Optimization Strategy (MOST) [20] to evaluate the impact of different components in the monthly Screening Activity Report (SAR) delivered by email to primary care physicians across Ontario and an accompanying process evaluation
Summary
Health care provider behavior is an important determinant of patients’ use of screening services [1,2,3,4,5]. A number of knowledge translation strategies intended to target provider behavior already exist , including audit and feedback [6], reminder/recall systems [7], and incentives [8]. The effectiveness of these strategies varies considerably and may be partly explained by variation in the features of the interventions [6,7], the differing clinical contexts in which the interventions are used, and the extent to which clinicians engage with the interventions [9,10]. Analytics reveal that 50% of email recipients do not open the email and less than 7% click the embedded link to log in to their report
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