Increasing CRC Screening in Primary Care Settings

描述(申请人提供)：定期筛查可降低结直肠癌(CRC)的发病率和死亡率。然而，筛查率仍然很低，这表明需要进行旨在增加筛查行为的创新研究。这项研究的目的是比较两种干预措施(定制健康交流[THC]和动机访谈[MI])在增加结直肠癌筛查行为方面的有效性。这两种干预措施都基于源自健康信念模型(HBM)和跨理论模型(TTM)的强大概念框架，使我们能够探索这些干预措施影响行为变化的潜在机制。这项研究的主要目的是比较随机分配到控制或干预条件下的804名参与者中CRC筛查测试的使用情况；将从每个地点(德克萨斯州盐湖城和田纳西州纳什维尔)招募402名参与者。这三个研究小组将接受(1)标准护理，(2)量身定制的健康交流，(3)动机访谈。研究参与者的资格标准包括50岁或以上，没有结直肠癌，以及患有结直肠癌的风险为中等或中等。研究参与者将通过电话调查干预前(时间1)、干预后1个月(时间2)、6个月和12个月(分别为时间3和4)的CRC相关信念。Salt Like City的参与者将主要是高加索人，来自纳什维尔的人将是非裔美国人。将评估两种行为结果(是否有筛查试验)和CRC筛查试验采用的阶段(基于TTM)，以及筛查行为的社会人口学和信念预测因素。二项和多项Logistic回归模型将用于评估筛查、测试使用和测试采用的阶段。社会人口学和信仰变量将被用作协变量，干预组是主要的独立预测因素。描述性统计和方差分析将被用来评估不同干预措施在服从信念上的差异。将进行路径(中介)分析，以进一步探索THC和MI可能通过不同的方式影响CRC筛查行为的潜在机制。

DESCRIPTION (provided by applicant): Regular screening reduces both morbidity and mortality from colorectal cancer (CRC). Screening rates, however, remain low suggesting the need for innovative research designed to increase screening behavior. The purpose of this study is to compare the effectiveness of two interventions (Tailored Health Communications [THC] and Motivational Interviewing [MI]) in increasing CRC screening behavior. Both interventions are based on a strong conceptual framework derived from the Health Belief Model (HBM) and Transtheoretical Model (TTM), allowing us to explore the underlying mechanisms through which these interventions impact behavior change. The primary aim of this study is to compare CRC screening test use among 804 participants randomly allocated to control or intervention conditions; 402 participants will be recruited from each site (Salt Lake City, UT and Nashville, TN). The three study groups will receive (1) standard care, (2) tailored health communication, and (3) motivational interviewing. Eligibility criteria for study participants includes being 50 years or older, not having CRC, and being of average or moderate risk for CRC. Study participants will be surveyed by telephone about CRC related beliefs pre-intervention (Time 1), one month post intervention (Time 2), and at 6 and 12 months (Times 3 and 4 respectively). Salt Like City participants will be primarily Caucasian and those from Nashville will be African American. Dichotomous behavioral outcomes (had screening test or not) and stages of CRC screening test adoption (based on the TTM) will be assessed, as well as sociodemographic and belief predictors of screening behavior. Binomial and multinomial logistic regression models will be used to evaluate screening test use and stage of test adoption. Sociodemographic and belief variables will be used as covariates, with intervention groups at the primary independent predictor. Descriptive statistics and ANOVA will be employed to assess between intervention differences in amenable beliefs. Path (mediation) analysis will be performed to further explore the underlying mechanisms through which THC and MI may differentially affect CRC screening behavior.