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

描述（由申请人提供）：2000年NHIS的数据显示，在美国，只有大约一半的符合年龄的女性在进行乳房x光检查——定期进行乳房x光检查。需要定期进行乳房x光检查，以减轻乳腺癌的人口负担，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4040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）的妇女的维持费用，这是一个非常庞大的妇女人口，代表了不同职业和背景的妇女。SHP由北卡罗来纳蓝十字和蓝盾公司（BCBSNC）管理，该公司也是健康计划的管理机构，该计划是构建本研究的一部分——PRISM，关于筛查乳房x光检查的个人相关信息。提出的研究是PRISM2。我们的目标是确定M.I.N.C，即改变所需的最小干预。我们建议完善自适应干预系统，基于我们以前的工作，使用阶梯式护理模型和量身定制的干预措施。根据适应性模型，所有女性每年都会收到三种乳房x光检查提醒中的一种——常规护理，这代表了女性通常收到的提醒类型，与基于劝导性沟通原则的增强信件或自动电话提醒相比，旨在通过将其视为简短的劝导性沟通来提高提醒的有效性。在任何干预年份的6个月内对这些简短干预没有反应的妇女将接受第二步，一个简短的电话咨询干预，重点是克服障碍，或者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，并在第一次提醒后的12、24、36和48个月进行电话随访。我们既在妇女个人层面上工作，也在男女共同层面上工作。我们假设，增强的提醒将更有可能导致坚持和维护比通常的护理提醒。接到障碍电话并详细说明后果的妇女最有可能重新坚持下去。我们的干预是由健康信念模型、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阐述人们如何处理健康信息的理论可能性模型提供的。理解行为过程和信息处理是很重要的。我们在北卡罗来纳大学教堂山分校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，以及一群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。我们的设计是为了传播，这样，如果这些干预措施有效，就会被采纳。

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.