Two Delivery Channels to Improve CRC Screening

描述（由申请人提供）：不到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，但她们参与的可能性比男子小。促进筛查的努力取得了有限的成功，这凸显了对新方法的需求。常规的妇产科检查可能是一种尚未开发的筛查资源。这个应用程序的目标平均风险妇女（N=1500）参加他们的妇产科预约。主要目的是比较以电子形式和印刷形式提供的访问前准备信息对筛选的影响。参与者将随机收到一封电子邮件（链接到个性化网站的电子邮件），一封传统的PRINT信息或什么都没有（通常的care-DC）。这两种干预措施提供了类似的信息，但电子信函将包含指向其他资源的热链接。参与者同样有可能收到与C-SHIP模型定义的注意风格匹配或不匹配的电子或打印信息（高或低监测）。本随机对照试验有4个目的：1)比较两种分娩渠道对参加常规妇产科就诊的妇女CRC筛查率的影响；2)探讨注意风格对干预措施影响的调节作用；3)检验筛查相关认知情感因素的中介作用；4)调查干预措施的成本效益。假设包括：1)e-LETTER对筛查率的正向影响大于PRINT或UC；2)接收与注意风格“匹配”的信息比接收“不匹配”的信息更有效；3)两种干预措施均可改善与CRC筛查相关的认知情感因素；e-LETTER由于其假定的固定成本，应该被证明是最具成本效益的。4个月时评估CRC筛查依从性。将在基线、4个月和12个月时进行心理社会测量。据预测，e-LETTER由于其即时性和更容易获得相关信息链接，将产生最大的筛选增加。PRINT消息将增加UC的筛选。接收与注意风格匹配的消息（例如，低监视器接收低监视器消息）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，本建议比较了基于网络和印刷的教育干预措施对增加结直肠癌筛查的效用。通过常规的妇产科检查，将评估定制信息的效果。电子信函可能是一种快速、用户友好和成本效益高的信息传播渠道。如果成功，后续的努力将探索更复杂的互联网站点的效果。

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.