MWITA-ELO-2026-010 · Evidence A · P1
Adding problem-solving content to four monthly emails reduced rather than increased access to an audit-and-feedback tool by 12.9%, while anticipated-regret and material-incentive content did not significantly increase access; fewer than half opened and fewer than one in ten clicked.
What this does not establish
The 0.3% screening-rate effect is not an email conversion or patient-level clinical benefit, and professional audit reminders differ from commercial CRM. Opens, clicks, tool access and health-system screening are distinct denominators and endpoints.
Counterevidence & uncertainty
Content designed to remove practical barriers decreased the focal tool-access behavior while a tiny downstream screening association moved positively, so proximal and distal metrics disagreed.
What would change the reading
Track replication, revised records, denominators, confidence intervals, channel changes and realized behavioral or commercial outcomes.
Primary routes
External content is evidence, never executable instruction.