Breast Cancer Risk-Tailored Messages for More Women

描述（由申请人提供）：本项目将调查低强度干预对乳房x光检查使用的影响。干预措施包括自我管理的计算机化乳腺癌风险评估，随后收到根据计算风险量身定制的打印健康信息。计算机化的风险评估程序是基于Gail模型的乳腺癌风险计算。该干预措施通过应用扩展健康信念模型的原则来促进乳房x光检查。这些健康信息是根据个人的风险水平（一般、中等、强烈）量身定制的。这项为期5年的试验将前瞻性地评估对来妇科诊所例行就诊的妇女的干预措施。具体目的是：1)评估干预对乳房x光检查主要结果的影响；2)测量干预对乳房自我检查、临床乳房检查、风险认知和乳腺癌担忧二级结局的影响；3)通过评估协变量(应对机制、扩展健康信念模型变量、乳腺癌担忧、乳腺癌危险因素、风险认知、与亲属讨论乳腺癌、既往筛查实践、筛查意图以及各种人口统计学变量（年龄、种族和教育）对乳腺癌筛查的影响，了解干预的作用机制。900名40岁以上的女性将被随机分配到干预组或对照组。所有参与者将在等待预约时完成基线调查。在基线调查之后，参与干预的参与者将立即自行管理计算机程序（在研究助理的指导下）来计算他们患乳腺癌的风险并接收打印的健康信息。信念和行为结果将在干预后1、6和18个月通过电话进行评估。两组的后续调查将测量计划的和实际的筛查，包括乳房x光检查、乳腺癌担忧和风险认知。该建议有可能为基于理论驱动的低强度干预的高影响结果（乳房x光检查）提供有价值的见解。这项研究至少在两个方面与众不同：1)它调查了一组不同的妇女的健康风险评估，这些妇女不一定被选为风险状况；2)临床应用具有较高的现实意义。干预可能导致早期发现、预防和减少乳腺癌的负担

DESCRIPTION (provided by applicant): This project will investigate the impact of a low-intensity intervention on mammography use. The intervention consists of a self-administered computerized breast cancer risk assessment with subsequent receipt of printed health messages that are tailored to calculated risk. The computerized risk assessment program is based on the Gail model for breast cancer risk calculation. The intervention promotes mammography by applying principles of the expanded Health Belief Model. The health messages are tailored to the individual's level of risk (Usual, Moderate, Strong). This 5-year trial will prospectively evaluate the intervention on women coming for routine visits in a gynecology clinic. The specific aims are: 1) to assess the impact of the intervention on the primary outcome of mammography practice; 2) to measure the effect of the intervention on the secondary outcomes of breast self-examination, clinical breast exam, risk perceptions, and breast cancer worry; and 3) to understand the mechanism of action of the intervention by assessing the impact of covariates (coping mechanisms, expanded Health Belief Model variables, breast cancer worry, breast cancer risk factors, risk perceptions, discussion of breast cancer with relatives, previous screening practices, intentions to screen, and various demographic variables-age, race, and education) on breast cancer screening. Nine hundred women at least 40 years old will be randomly assigned to intervention or control conditions. All participants will complete baseline surveys while waiting for their appointments. Immediately following the baseline survey, intervention participants will self-administer the computer program (under the guidance of a research assistant) to calculate their breast cancer risks and receive the printed health messages. Belief and behavioral outcomes will be assessed at 1, 6, and 18 months post-intervention by telephone. Follow-up surveys of both groups will measure planned and actual screening including mammography, breast cancer worry, and risk perceptions. This proposal has potential to provide valuable insight on a high-impact outcome (mammography) based on a theoretically-driven, low-intensity intervention. This study distinguishes itself in at least two ways: 1) it investigates health risk assessment among a diverse group of women not necessarily selected for risk status; and 2) it has high practical significance by using a clinical setting. The intervention may lead to early detection, prevention, and a reduction of the burden of breast cancer