FINDING THE M.I.N.C. FOR MAMMOGRAPHY MAINTENANCE

寻找 M.I.C.

• 批准号: 7121708
• 负责人: BARBARA K. RIMER
• 金额: $ 14.75万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7121708
• 关键词: breast neoplasm /cancer diagnosis; cancer prevention; clinical research; disease /disorder prevention /control; female; human middle age (35-64); human old age (65+); human subject; interview; longitudinal human study; mammography; women' s health

DESCRIPTION (provided by applicant): Data from the 2000 NHIS show that only about half the age-eligible women in the U.S. are in maintenance for mammography--getting regular mammograms. Regular mammography use is required to reduce the population burden of breast cancer, resulting in earlier detection of breast cancer and lower disease mortality. We aim to increase maintenance among 4040 initially adherent women who are members of the North Carolina Teachers' and State Employees' Comprehensive Major Medical Plan (SHP), a very large population of women, representing women of diverse occupations and backgrounds. The SHP is administered by Blue Cross and Blue Shield of North Carolina (BCBSNC), which also was the administrator of the health plans that were part of the study on which this one is built-- PRISM, Personally Relevant Information about Screening Mammography. The proposed research is PRISM2. Our goal is to identify the M.I.N.C., Minimum Intervention Needed for Change. We propose to refine an adaptive intervention system, based on our previous work using stepped care models and tailored interventions. Following the adaptive model, all women annually will receive one of three kinds of mammography reminders--Usual Care, which represents the kinds of reminders women usually receive, compared to Enhanced Letter or Automated Telephone Reminders based on persuasive communication principles and designed to increase the efficacy of reminders by treating them as brief persuasive communications. Women who do not respond to these brief interventions within 6 months in any intervention year will receive step 2, a brief telephone counseling intervention that focuses either on overcoming barriers or supplementing this by encouraging women to also elaborate either on the positive consequences of getting mammograms or the negative consequences of not getting them. A control condition for the call will help us assess the incremental impact of telephone counseling following reminders. We will conduct baseline telephone interviews prior to intervention and follow-up interviews by telephone 12, 24, 36 and 48 months from first reminders. We are working at the level of both individual women and SHP. We hypothesize that enhanced reminders will be more likely to lead to adherence and maintenance than usual care reminders. Women who receive barriers calls with elaboration of consequences will be most likely to return to adherence. Our interventions are informed by the Health Belief Model, Theory of Reasoned Action, Model of Goal- Directed Behavior and theories appropriate to study maintenance as well as the Elaboration Likelihood Model, a theory that addresses how people process health information. Understanding both behavioral processes and information processing is important. We have a highly experienced team of researchers and support staff at The University of North Carolina at Chapel Hill and Duke University and an outstanding group of consultants and collaborators. This research has the potential to dramatically increase mammography maintenance. We have designed for dissemination so that, if effective, the interventions will be adopted.

描述（由申请人提供）：2000年NHIS的数据显示，美国只有大约一半的适龄妇女接受乳房X光检查--定期接受乳房X光检查。需要定期使用乳房X光检查，以减少乳腺癌的人口负担，从而及早发现乳腺癌并降低疾病死亡率。我们的目标是增加4 040名最初加入北卡罗来纳州教师和州雇员综合主要医疗计划（SHP）的妇女的生活费，这是一个非常庞大的妇女群体，代表了不同职业和背景的妇女。SHP由北卡罗来纳州的蓝十字和蓝盾（BCBSNC）管理，BCBSNC也是健康计划的管理者，这些计划是本研究的一部分- PRISM，关于筛查乳房X光检查的个人相关信息。该研究是PRISM 2。我们的目标是找出失踪人员改变需要最少的干预。我们建议完善自适应干预系统，根据我们以前的工作，使用阶梯式护理模式和量身定制的干预措施。根据自适应模式，所有妇女每年都会收到三种乳房X光检查提醒之一-乳房护理，这是妇女通常收到的提醒类型，而增强型信函或自动电话提醒则基于说服性沟通原则，旨在通过将其视为简短的说服性沟通来提高提醒的有效性。在任何干预年的6个月内对这些简短干预措施没有反应的妇女将接受第二步，这是一种简短的电话咨询干预措施，重点是克服障碍，或通过鼓励妇女详细说明接受乳房X光检查的积极后果或不接受乳房X光检查的消极后果来补充这一点。电话咨询的控制条件将帮助我们评估电话咨询在提醒后的增量影响。我们将在干预前进行基线电话访谈，并在第一次提醒后12、24、36和48个月进行电话随访。我们在妇女个人和小水电两个层面开展工作。我们假设，增强的提醒将更有可能导致遵守和维护比通常的护理提醒。收到障碍电话并详细说明后果的妇女最有可能恢复依从性。我们的干预措施是由健康信念模型，理性行动理论，目标导向行为模型和适合研究维护的理论以及埃克塞特李克鲁模型，一个解决人们如何处理健康信息的理论所告知的。理解行为过程和信息处理都很重要。我们在位于查佩尔山的北卡罗来纳州大学和杜克大学拥有一支经验丰富的研究人员和支持人员团队，以及一批杰出的顾问和合作者。这项研究有可能大大增加乳房X光检查的维护。我们设计了传播方案，以便如果干预措施有效，就会被采纳。