ACHIEVING REPEAT MAMMOGRAPHY--STEPPED-CARE/ SELF-CHOICE

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DESCRIPTION: This three year, community-based study addresses an important challenge for screening mammography: that is identifying intervention strategies which can help to promote repeated screening among women who have had a recent mammogram (N=2120; women aged 50-74). Rates of repeated mammography still appear to be no more than 40 percent among women of that age group. The Specific Aims of the proposed research are: 1. To examine whether intervening with women in the month following their mammogram (Short term Follow-up) results in a higher percentage of repeat screening compared to interventions which are delayed until two months before the next mammogram is due (Delayed Follow-up: Mailed Reminder, Phone Reminder); 2. To determine if a 'stepped-care' intervention methodology, which is delivered in both the Short term Follow-up and the Delayed Follow-up conditions, results in a higher percentage of repeat screening compared to either a simple reminder sent by mail (Mailed Reminder) or delivered by telephone (Phone Reminder); 3. To investigate whether giving women the option for self-selection of an intervention group, compared to the random assignment of women into intervention groups, affects the rates of repeated screening which are observed; 4. To employ a research and data collection design which attempts to minimize complete refusals and lost to follow-up, in order to examine questions pertinent to recruitment and retention bias. Therefore, there are four distinct intervention groups in this proposed project: 1) Short term Follow-up; 2) Delayed Follow-up; 3) Telephone Reminder Notice; 4) Mailed Reminder Notice. Groups 1 and 2 include a personal call to discuss barriers to screening as part of the stepped- care. The second element of the study has two arms -- 1) Traditional Random Assignment versus 2) Self- Selection. Traditional Random Assignment assigns the intervention by standard randomization procedures. The Self-Selection arm offers women the opportunity to choose the intervention group. This project is a collaboration between Brown and Duke Universities. Women will be recruited from a statewide HMO and a large radiology practice.