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

描述(申请人提供)：2000年NHIS的数据显示，在美国，只有大约一半符合年龄条件的女性需要接受乳房X光检查--定期进行乳房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，从而更早地发现乳腺癌并降低疾病死亡率。我们的目标是增加参加北卡罗来纳州教师和州雇员综合重大医疗计划(SHP)的4040名最初加入该计划的妇女的赡养费，SHP是一个非常庞大的妇女人口，代表着不同职业和背景的妇女。SHP由北卡罗来纳州蓝十字和蓝盾(BCBSNC)管理，BCBSNC也是健康计划的管理者，该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。建议的研究是PRISM2。我们的目标是确定MI.N.C.，即改变所需的最低限度的干预。我们建议在我们以前工作的基础上，使用阶梯式护理模式和量身定做的干预措施来完善适应性干预系统。根据自适应模型，所有女性每年都将收到三种乳房X光检查提醒之一--通常护理，这代表了女性通常收到的提醒类型，而不是基于说服性沟通原则的增强型信件或自动电话提醒，旨在通过将提醒视为简短的说服性沟通来提高提醒的效率。在任何干预年的6个月内，对这些简单干预措施没有反应的女性将得到第二步，这是一种简短的电话咨询干预，重点是克服障碍，或者通过鼓励女性详细说明接受乳房X光检查的积极后果或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，并在首次提醒后12、24、36和48个月通过电话进行后续访谈。我们既在妇女个人层面上工作，也在SHP层面上工作。我们假设，与通常的护理提醒相比，增强提醒将更有可能导致坚持和维护。那些接到障碍电话并详细说明后果的女性，最有可能回归坚守承诺。我们的干预措施受到健康信念模型、理性行动理论、目标导向行为模型和适用于研究维护的理论的启发，以及精加工可能性模型，这是一种解决人们如何处理健康信息的理论。理解行为过程和信息处理都很重要。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团队和支持人员团队，以及一批杰出的顾问和合作者。这项研究有可能极大地增加乳房X光检查的维护。我们为传播而设计，以便如果有效，干预措施将被采用。

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.