Disparities and Behavioral Predictors of Mammogram Completion Following Digital Reminders

Objective: To examine Electronic Health Record (EHR)-derived predictors of mammogram completion following a digital screening reminder, with attention to behavioral engagement and disparities. Methods: We conducted a retrospective cohort study of women aged 50–75 at a large academic medical center. Logistic regression was used to assess sociodemographic, socioeconomic, and engagement- related predictors of screening completion within 90 days of a reminder. Results: Traditional sociodemographic variables (e.g., income, insurance type, marital status) were not significantly associated with screening adherence. In contrast, higher prior no-show and cancellation rates were strongly associated with non-completion (OR = 0.12, p < .001). Hispanic ethnicity and younger age were also associated with lower adherence. Discussion: Findings suggest that behavioral engagement, as captured by prior appointment patterns, may reflect practical or psychosocial barriers to preventive care that static demographic variables fail to detect. These engagement indicators may therefore offer a more actionable lens for understanding missed screenings. Conclusions: Behavioral engagement measures showed the strongest associations with mammogram completion. Leveraging these indicators may improve identification of patients at risk for non-adherence and guide targeted, culturally responsive outreach strategies to reduce screening disparities.