{"doi":"10.1136/bmj.n1022","title":"Behavioral interventions to improve population health outreach for hepatitis C screening: randomized clinical trial","abstract":"OBJECTIVE: To evaluate whether opt out framing, messaging incorporating behavioral science concepts, or electronic communication increases the uptake of hepatitis C virus (HCV) screening in patients born between 1945 and 1965. DESIGN: Pragmatic randomized controlled trial. SETTING: 43 primary care practices from one academic health system (Philadelphia, PA, USA) between April 2019 and May 2020. PARTICIPANTS: Patients born between 1945 and 1965 with no history of screening and at least two primary care visits in the two years before the enrollment period. INTERVENTIONS: This multilevel trial was divided into two studies. Substudy A included 1656 eligible patients of 17 primary care clinicians who were randomized in a 1:1 ratio to a mailed letter about HCV screening (letter only), or a similar letter with a laboratory order for HCV screening (letter+order). Substudy B included the remaining 19 837 eligible patients followed by 417 clinicians. Active electronic patient portal users were randomized 1:5 to receive a mailed letter about HCV screening (letter), or an electronic patient portal message with similar content (patient portal); inactive patient portal users were mailed a letter. In a factorial design, patients in substudy B were also randomized 1:1 to receive standard content (usual care), or content based on principles of social norming, anticipated regret, reciprocity, and commitment (behavioral content). MAIN OUTCOME MEASURES: Proportion of patients who completed HCV testing within four months. RESULTS: 21 303 patients were included in the intention-to-treat analysis. Among the 1642 patients in substudy A, 19.2% (95% confidence interval 16.5% to 21.9%) completed screening in the letter only arm and 43.1% (39.7% to 46.4%) in the letter+order arm (P<0.001). Among the 19 661 patients in substudy B, 14.6% (13.9% to 15.3%) completed screening with usual care content and 13.6% (13.0% to 14.3%) with behavioral science content (P=0.06). Among active patient portal users, 17.8% (16.0% to 19.5%) completed screening after receiving a letter and 13.8% (13.1% to 14.5%) after receiving a patient portal message (P<0.001). CONCLUSIONS: Opt out framing and effort reduction by including a signed laboratory order with outreach increased screening for HCV. Behavioral science messaging content did not increase uptake, and mailed letters achieved a greater response rate than patient portal messages. TRIAL REGISTRATION: ClinicalTrials.gov NCT03712553.","journal":"BMJ","year":2021,"id":170839,"datarank":0.88509370035537,"base_score":3.332204510175204,"endowment":3.332204510175204,"self_citation_contribution":0.49983067652628066,"citation_network_contribution":0.38526302382908945,"self_endowment_contribution":0.49983067652628066,"citer_contribution":0.38526302382908945,"corpus_percentile":null,"corpus_rank":null,"citation_count":27,"citer_count":16,"citers_with_citation_signal":10,"citers_with_endowment":10,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9443,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03712553"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":704468,"name":"Susan Day","orcid":null,"position":1,"is_corresponding":false},{"id":304337,"name":"Anne Norris","orcid":"0000-0003-3797-7416","position":2,"is_corresponding":false},{"id":667402,"name":"Jessica Sung","orcid":null,"position":3,"is_corresponding":false},{"id":281587,"name":"Catherine Reitz","orcid":"0000-0002-5393-374X","position":4,"is_corresponding":false},{"id":704469,"name":"Colin Wollack","orcid":null,"position":5,"is_corresponding":false},{"id":618168,"name":"Christopher K. Snider","orcid":"0000-0001-7064-4352","position":6,"is_corresponding":false},{"id":231973,"name":"Pamela A. Shaw","orcid":"0000-0003-1883-8410","position":7,"is_corresponding":false},{"id":281593,"name":"David A. Asch","orcid":"0000-0002-7970-286X","position":8,"is_corresponding":false},{"id":281585,"name":"Shivan J. Mehta","orcid":"0000-0001-6066-4739","position":0,"is_corresponding":true}],"reference_count":45,"raw_metadata":null,"created_at":"2026-07-18T23:46:24.040760Z","pmid":"34006604","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}