Increasing CRC Screening in Primary Care Settings

描述（由申请人提供）：定期筛查可降低结直肠癌（CRC）的发病率和死亡率。然而，筛查率仍然很低，这表明需要进行旨在增加筛查行为的创新研究。本研究的目的是比较两种干预措施（定制健康沟通[THC]和动机访谈[MI]）在增加CRC筛查行为方面的有效性。这两种干预措施都基于健康信念模型（HBM）和跨理论模型（TTM）的强大概念框架，使我们能够探索这些干预措施影响行为变化的潜在机制。本研究的主要目的是比较随机分配到对照或干预条件的804名参与者中CRC筛查测试的使用情况;将从每个研究中心（犹他州湖城和田纳西州纳什维尔）招募402名参与者。三个研究组将接受（1）标准护理，（2）量身定制的健康沟通，（3）动机访谈。研究参与者的资格标准包括50岁或以上，没有CRC，并且具有CRC的平均或中度风险。将通过电话调查研究参与者在干预前（时间1）、干预后1个月（时间2）以及6个月和12个月（分别为时间3和4）的CRC相关信念。盐一样的城市参与者将主要是白人和那些从纳什维尔将是非洲裔美国人。将评估二分行为结局（是否进行筛选试验）和CRC筛选试验采用阶段（基于TTM），以及筛选行为的社会人口统计学和信念预测因素。将使用二项和多项逻辑回归模型评价筛选试验的使用和试验采用阶段。社会人口统计学和信念变量将被用作协变量，干预组是主要的独立预测因素。将采用描述性统计和方差分析来评估干预措施之间在顺从信念方面的差异。将进行路径（中介）分析，以进一步探索THC和MI可能差异影响CRC筛查行为的潜在机制。

DESCRIPTION (provided by applicant): Regular screening reduces both morbidity and mortality from colorectal cancer (CRC). Screening rates, however, remain low suggesting the need for innovative research designed to increase screening behavior. The purpose of this study is to compare the effectiveness of two interventions (Tailored Health Communications [THC] and Motivational Interviewing [MI]) in increasing CRC screening behavior. Both interventions are based on a strong conceptual framework derived from the Health Belief Model (HBM) and Transtheoretical Model (TTM), allowing us to explore the underlying mechanisms through which these interventions impact behavior change. The primary aim of this study is to compare CRC screening test use among 804 participants randomly allocated to control or intervention conditions; 402 participants will be recruited from each site (Salt Lake City, UT and Nashville, TN). The three study groups will receive (1) standard care, (2) tailored health communication, and (3) motivational interviewing. Eligibility criteria for study participants includes being 50 years or older, not having CRC, and being of average or moderate risk for CRC. Study participants will be surveyed by telephone about CRC related beliefs pre-intervention (Time 1), one month post intervention (Time 2), and at 6 and 12 months (Times 3 and 4 respectively). Salt Like City participants will be primarily Caucasian and those from Nashville will be African American. Dichotomous behavioral outcomes (had screening test or not) and stages of CRC screening test adoption (based on the TTM) will be assessed, as well as sociodemographic and belief predictors of screening behavior. Binomial and multinomial logistic regression models will be used to evaluate screening test use and stage of test adoption. Sociodemographic and belief variables will be used as covariates, with intervention groups at the primary independent predictor. Descriptive statistics and ANOVA will be employed to assess between intervention differences in amenable beliefs. Path (mediation) analysis will be performed to further explore the underlying mechanisms through which THC and MI may differentially affect CRC screening behavior.