{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:22:24Z","timestamp":1791656544588,"version":"4.3.4"},"reference-count":43,"publisher":"BMJ","license":[{"start":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T00:00:00Z","timestamp":1621296000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design<\/jats:title>\n            <jats:p>Pragmatic randomized controlled trial.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting<\/jats:title>\n            <jats:p>43 primary care practices from one academic health system (Philadelphia, PA, USA) between April 2019 and May 2020.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Participants<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Interventions<\/jats:title>\n            <jats:p>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\u2009837 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).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main outcome measures<\/jats:title>\n            <jats:p>Proportion of patients who completed HCV testing within four months.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>21\u2009303 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&lt;0.001). Among the 19\u2009661 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&lt;0.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>\n              ClinicalTrials.gov\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT03712553\" ext-link-type=\"clintrialgov\">NCT03712553<\/jats:ext-link>\n              .\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1136\/bmj.n1022","type":"journal-article","created":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T15:21:41Z","timestamp":1621351301000},"page":"n1022","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Behavioral interventions to improve population health outreach for hepatitis C screening: randomized clinical trial"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"nct03712553","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03712553","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6066-4739","authenticated-orcid":false,"given":"Shivan J","family":"Mehta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan C","family":"Day","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne H","family":"Norris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Sung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Reitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Wollack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher K","family":"Snider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela A","family":"Shaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"Asch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,18]]},"reference":[{"key":"2021051812200826000_373.may18_2.n1022.1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.07.056"},{"key":"2021051812200826000_373.may18_2.n1022.2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27969"},{"key":"2021051812200826000_373.may18_2.n1022.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1402454"},{"key":"2021051812200826000_373.may18_2.n1022.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1512610"},{"key":"2021051812200826000_373.may18_2.n1022.5","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-159-5-201309030-00672"},{"key":"2021051812200826000_373.may18_2.n1022.6","first-page":"1","article-title":"Recommendations for the identification of chronic hepatitis C virus infection among persons born during 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