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

寻找 M.I.C.

• 批准号: 6806558
• 负责人: BARBARA K. RIMER
• 金额: $ 66.6万
• 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 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6806558
• 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符合年龄条件的女性正在接受乳房 X 光检查——定期进行乳房 X 光检查。需要定期使用乳房X光检查来减轻乳腺癌的人口负担，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 4040 名最初加入的女性的赡养费，这些女性是北卡罗来纳州教师和州雇员综合主要医疗计划 (SHP) 的成员，这些女性人数非常多，代表了不同职业和背景的女性。 SHP 由北卡罗来纳州 Blue Cross and Blue Shield (BCBSNC) 管理，该计划也是健康计划的管理机构，该计划是该计划所依据的研究的一部分 - PRISM，有关筛查乳房 X 光检查的个人相关信息。拟议的研究是 PRISM2。我们的目标是确定 M.I.N.C.（变革所需的最小干预）。我们建议根据我们之前的工作，使用阶梯式护理模式和量身定制的干预措施来完善适应性干预系统。按照适应性模式，所有女性每年都会收到三种乳房X光检查提醒中的一种——日常护理，它代表女性通常收到的提醒类型，而增强型信件或自动电话提醒则基于说服性沟通原则，旨在通过将提醒视为简短的说服性沟通来提高提醒的有效性。在任何干预年度的 6 个月内对这些简短干预措施没有做出反应的女性将接受第 2 步，即简短的电话咨询干预，重点是克服障碍或通过鼓励女性详细说明接受乳房 X 光检查的积极后果或不接受乳房 X 光检查的负面后果来补充这一点。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。我们在个体女性和小水电层面开展工作。我们假设增强的提醒比通常的护理提醒更有可能导致依从性和维护。收到详细说明后果的障碍电话的女性最有可能恢复遵守。我们的干预措施以健康信念模型、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可能性模型（一种解决人们如何处理健康信息的理论）为基础。了解行为过程和信息处理很重要。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人员和支持人员团队，以及一支优秀的顾问和合作者团队。这项研究有可能显着提高乳房X光检查的维护率。我们设计了传播措施，以便如果有效，干预措施就会被采用。