WOMEN VETERANS AND BREAST CANCER SCREENING

我们建议进行为期5年的前瞻性随机试验，进行基于理论的干预，以提高52岁及以上女性退伍军人对乳房X光检查指南的遵从性。该项目的具体目标是：1)开发和评估基于跨理论模型(TTM)的干预措施的有用性，以提高项目期间的遵从性(完成两次乳房X光检查)和覆盖率(完成至少一次乳房X光检查)；2)分析一些预测变量与遵从性和覆盖率的关系；以及3)进行成本效益分析，以提高对乳房X光检查建议的遵从性。我们将从国家女退伍军人登记处(NRWV)随机抽样7500名52岁及以上的女性，这是一个计算机化的数据库，包括自1942年1月1日以来脱离现役的大约150-180万名女退伍军人中的1.5人。参与者将被随机分到五组中的一组。第1组和第2组将被用来评估有针对性的(针对个人变化阶段的)干预与有针对性的、量身定制的(包括个性化反馈)干预。第一组和第二组将收到一本基于TTM的教育小册子。第一组还将收到一封根据对TTM的结构(例如决策平衡、变化过程)以及其他行为变化模型的结构进行衡量的调查的反馈信，而第二组将收到一封鼓励筛选的通用信函。第一组和第二组将进行两轮干预。第三、第四和第五组为对照组，只接受调查(S)。第三组将是我们衡量干预效果的主要对照组；第四组和第五组将用于评估调查的长期趋势和衡量效果。项目材料将邮寄，未回答的人将通过电话跟进。将通过自我报告来确定乳房X光检查的状况，并将对结果进行验证研究。在这一点上，我们对如何让女性保持定期乳房X光检查或其成本效益知之甚少。已经进行或正在进行的为数不多的研究侧重于疗效。这项拟议的研究将评估在具有全国代表性、定义明确的妇女群体中增加定期乳房X光检查的持续干预措施的有效性。如果干预被证明是有效的，基础设施已经到位，以使干预制度化。

We propose a 5-year prospective randomized trial of a theory-based intervention to increase compliance with mammography screening guidelines in female veterans 52 years of age and over. Specific aims of the project are to: 1) develop and evaluate the usefulness of an intervention based on the Transtheoretical Model (TTM) to increase compliance (completion of two mammograms) and coverage (completion of at least one mammogram) during the project; 2) analyze the relationship of a number of predictor variables with compliance and coverage; and 3) conduct a cost-effectiveness analysis of increasing compliance with mammography screening recommendations. We will randomly sample 7,500 women 52 years of age and over from the National Registry of Women Veterans (NRWV), a computerized database including 1.5 of the estimated 1.5-1.8 million women veterans separated from active military duty since January 1, 1942. Participants will be randomized to one of five groups. Groups 1 and 2 will be used to evaluate a targeted (aimed at an individual's stage of change) vs. a targeted and tailored (inclusion of personalized feedback) intervention. Groups 1 and 2 will receive an educational booklet based on the TTM. Group 1 also will receive a tailored feedback letter based on responses to a survey that measures constructs from the TTM (e.g., decisional balance, processes of change), as well as constructs from other behavior change models, while group 2 will receive a generic letter encouraging screening. There will be two rounds of the intervention for groups 1 and 2. Groups 3, 4, and 5 are control groups that will receive only the survey(s). Group 3 will be the primary control group against which we will measure the effect of the intervention; groups 4 and 5 will be used to evaluate secular trends and measurement effects of the surveys. Project materials will be mailed, and nonrespondents will be followed up by telephone. Mammography screening status will be ascertained by self-report, and a validation study will be conducted of the outcome measure. At this point, we know very little about how to get women to maintain regular mammography screening or about its cost-effectiveness. The few studies that have been conducted, or that are in progress, have focused on efficacy. The proposed research will evaluate the effectiveness of a sustained intervention to increase regular mammography in a nationally representative, well-defined population of women. The infrastructure is in place to institutionalize the intervention should it prove to be effective.