Two Delivery Channels to Improve CRC Screening

描述（由申请人提供）：低于50%的平均风险人群坚持结肠直肠癌（CRC）筛查建议。尽管妇女承受着更大的疾病负担，但她们参加的可能性低于男子。促进筛查的努力取得了有限的成功，突出了对新方法的需求。常规Ob/Gyn访视可能代表一种未开发的筛查资源。该应用程序的目标是平均风险的妇女（N=1500）参加他们的妇产科预约。主要目的是比较电子与印刷格式提供的访视前准备信息的筛选效果。受试者将随机接受电子邮件（链接到个性化网站的电子邮件），传统的打印消息或什么都没有（常规护理-DC）。这两项干预措施提供了类似的信息，但电子信函将包含其他资源的热链接。参与者将同样有可能收到与C-SHIP模型定义的注意力风格（高与低监测）匹配或不匹配的电子或印刷信息。本随机对照试验有4个目的：1）比较2种分娩方式对常规妇产科就诊妇女CRC筛查率的影响; 2）探讨注意方式对干预影响的调节作用; 3）检查与筛查相关的认知情感因素的中介作用; 4）调查干预的成本效益。假设包括：1）e-LETTER对筛查率的积极影响大于PRINT或UC; 2）接收与注意力类型“匹配”的信息比“不匹配”的信息更有效; 3）两种干预措施都将改善与CRC筛查相关的认知情感因素; 4）由于其假定的固定成本，e-LETTER应证明是最具成本效益的。将在4个月时评估CRC筛选依从性。将在基线、4个月和12个月时获得心理社会指标。据预测，电子信函由于其即时性和更容易获得相关信息链接，将使筛查增加最多。PRINT消息将增加UC的筛选。接收与注意力类型匹配的消息（例如，低监测器接收低监测器消息）将比不匹配的消息更有效。最后，电子干预将更具成本效益。总之，该提案比较了基于网络和印刷的教育干预措施的效用，以增加CRC筛查。使用常规妇产科访视，评估定制消息的有效性。电子信函有可能成为一种快速、方便用户和具有成本效益的信息传播渠道。如果成功的话，随后的努力可以探索更复杂的互联网网站的效果。

DESCRIPTION (provided by applicant): Fewer than 50% of the average risk population adheres to colorectal cancer (CRC) screening recommendations. Women are less likely than men to participate, despite suffering greater disease burden. Efforts to promote screening have displayed limited success, highlighting the need for novel approaches. The routine Ob/Gyn visit may represent an untapped screening resource. This application targets average risk women (N=1500) attending their Ob/Gyn appointment. The main goal is to compare the effect on screening of pre-visit preparatory messages delivered in electronical versus printed format. Participants will be randomized to receive an e-LETTER (email linked to a personalized website), a traditional PRINT message or nothing (usual care-DC). Both interventions provide similar information, but the e-LETTER will contain hotlinks to additional resources. Participants will be equally likely to receive their electronic or print messages matched or mismatched to their attentional style (high v. low monitoring) as defined by the C-SHIP model. This randomized controlled trial has 4 aims: 1) To compare the effect of 2 delivery channels on CRC screening rates for women attending routine Ob/GYN visits; 2) To explore the moderating role of attentional style on the impact of the interventions; 3) To examine the mediating effect of cognitive-affective factors related to screening; 4) To investigate the cost-effectiveness of the interventions. Hypotheses include: 1) The e-LETTER will have a greater positive impact on screening rates than PRINT or UC; 2) Receipt of messages "matched" to attentional style will be more effective than "mismatched" messages; 3) Both interventions will improve cognitive-affective factors related to CRC screening; and 4) e-LETTER should prove most cost-effective due to its presumed fixed costs. CRC screening adherence will be assessed at 4 months. Psychosocial measures will be obtained at baseline, 4 and 12 months. It is predicted that e-LETTER, will produce the greatest increase in screening given its immediacy and greater accessibility to related informational links. PRINT messages will increase screening over UC. Receipt of messages matched to attentional style (e.g. low monitor receives low monitor message) will be more effective than mismatched messages. Finally, electronic interventions will be more cost-effective. In summary, this proposal compares the utility of web-based and printed educational interventions to increase CRC screening. Using the routine Ob/Gyn visit, the efficacy of tailored messages will be assessed. The e-LETTER potentially represents a dissemination channel for information that is rapid, user-friendly, and cost-effective. If successful, subsequent efforts could explore the effect of more elaborate Internet sites.