WOMEN VETERANS AND BREAST CANCER SCREENING

我们提出了一项为期5年的前瞻性随机试验，以理论为基础的干预措施，以提高52岁及以上的女性退伍军人对乳腺X线摄影筛查指南的依从性。该项目的具体目标是：1）开发和评估基于跨理论模型（TTM）的干预措施的有效性，以提高依从性（完成两次乳房X光检查）和覆盖率（至少完成一次乳房X光检查）; 2）分析一些预测变量与依从性和覆盖率的关系;以及3）对提高对乳房X线检查建议的依从性进行成本效益分析。 我们将从国家退伍军人登记处（NRWV）随机抽取7，500名52岁及以上的女性，这是一个计算机化数据库，包括自1942年1月1日以来从现役军人中分离的估计150万至180万女性退伍军人中的150万。 参与者将被随机分配到五组中的一组。 第1组和第2组将用于评估有针对性的（针对个人的变化阶段）与有针对性的和定制的（包括个性化反馈）干预措施。 第1组和第2组将收到基于TTM的教育小册子。 第1组还将收到一封量身定制的反馈信，该反馈信基于对一项调查的回应，该调查测量了TTM的结构（例如，决策平衡，变化过程），以及其他行为变化模型的结构，而第2组将收到一封鼓励筛选的通用信。 第1组和第2组将进行两轮干预。第3、4和5组为对照组，仅接受调查。 第3组将是主要对照组，我们将衡量干预措施的效果;第4组和第5组将用于评估长期趋势和调查的测量效果。 项目材料将被邮寄，并将通过电话跟进。 将通过自我报告确定乳房X线摄影筛查状态，并对结局指标进行验证研究。 在这一点上，我们对如何让妇女保持定期乳房X光检查或其成本效益知之甚少。 已经进行或正在进行的少数研究都集中在疗效上。 拟议的研究将评估持续干预的有效性，以增加全国代表性的，明确定义的妇女人群的定期乳房X光检查。 如果干预措施证明是有效的，那么基础设施已经到位，可以将其制度化。

We propose a 5-year prospective randomized trial of a theory-based intervention to increase compliance with mammography screening guidelines in female veterans 52 years of age and over. Specific aims of the project are to: 1) develop and evaluate the usefulness of an intervention based on the Transtheoretical Model (TTM) to increase compliance (completion of two mammograms) and coverage (completion of at least one mammogram) during the project; 2) analyze the relationship of a number of predictor variables with compliance and coverage; and 3) conduct a cost-effectiveness analysis of increasing compliance with mammography screening recommendations. We will randomly sample 7,500 women 52 years of age and over from the National Registry of Women Veterans (NRWV), a computerized database including 1.5 of the estimated 1.5-1.8 million women veterans separated from active military duty since January 1, 1942. Participants will be randomized to one of five groups. Groups 1 and 2 will be used to evaluate a targeted (aimed at an individual's stage of change) vs. a targeted and tailored (inclusion of personalized feedback) intervention. Groups 1 and 2 will receive an educational booklet based on the TTM. Group 1 also will receive a tailored feedback letter based on responses to a survey that measures constructs from the TTM (e.g., decisional balance, processes of change), as well as constructs from other behavior change models, while group 2 will receive a generic letter encouraging screening. There will be two rounds of the intervention for groups 1 and 2. Groups 3, 4, and 5 are control groups that will receive only the survey(s). Group 3 will be the primary control group against which we will measure the effect of the intervention; groups 4 and 5 will be used to evaluate secular trends and measurement effects of the surveys. Project materials will be mailed, and nonrespondents will be followed up by telephone. Mammography screening status will be ascertained by self-report, and a validation study will be conducted of the outcome measure. At this point, we know very little about how to get women to maintain regular mammography screening or about its cost-effectiveness. The few studies that have been conducted, or that are in progress, have focused on efficacy. The proposed research will evaluate the effectiveness of a sustained intervention to increase regular mammography in a nationally representative, well-defined population of women. The infrastructure is in place to institutionalize the intervention should it prove to be effective.