Two Delivery Channels to Improve CRC Screening

描述(申请人提供)：只有不到50%的平均风险人群坚持结直肠癌(CRC)筛查建议。尽管承受着更大的疾病负担，但女性参与的可能性低于男性。促进筛查的努力收效甚微，凸显了采用新方法的必要性。常规的妇产科就诊可能代表未开发的筛查资源。该应用程序面向参加妇产科预约的中等风险女性(N=1500)。主要目标是比较电子形式和印刷形式发送的访问前准备信息在筛选方面的效果。参与者将被随机接受一封电子邮件(链接到个性化网站的电子邮件)、一条传统的印刷信息或什么都不接收(通常关注DC)。这两种干预措施都提供了类似的信息，但这封电子邮件将包含指向其他资源的热链接。参与者将同样有可能收到与C-SHIP模型定义的注意风格(高监控与低监控)匹配或不匹配的电子或印刷信息。这项随机对照试验有4个目的：1)比较两种分娩渠道对妇产科常规就诊妇女结直肠癌筛查率的影响；2)探讨注意方式对干预影响的调节作用；3)检验与筛查相关的认知-情感因素的中介作用；4)调查干预措施的成本-效果。假设包括：1)电子信件对筛查率的积极影响比纸质或UC更大；2)接收与注意风格相匹配的信息比接收与注意风格不匹配的信息更有效；3)这两种干预措施都将改善与CRC筛查相关的认知-情感因素；4)由于其假定的固定成本，电子信件应该被证明是最具成本效益的。结直肠癌筛查依从性将在4个月后进行评估。将在基线、4个月和12个月时获得心理社会措施。据预测，e-Letter，由于其即时性和更容易获得相关信息链接，将产生最大的筛选增加。打印消息将增加对UC的筛选。接收与注意风格匹配的消息(例如，低监控接收低监控消息)将比不匹配的消息更有效。最后，电子干预将更具成本效益。总之，这项建议比较了基于网络的教育干预和印刷教育干预在增加结直肠癌筛查方面的效用。使用常规的妇产科访问，将评估定制消息的效果。这封电子信件可能代表着一种传播信息的渠道，这种渠道既快捷、方便用户，又具有成本效益。如果成功，后续的努力可能会探索更复杂的互联网网站的影响。

DESCRIPTION (provided by applicant): Fewer than 50% of the average risk population adheres to colorectal cancer (CRC) screening recommendations. Women are less likely than men to participate, despite suffering greater disease burden. Efforts to promote screening have displayed limited success, highlighting the need for novel approaches. The routine Ob/Gyn visit may represent an untapped screening resource. This application targets average risk women (N=1500) attending their Ob/Gyn appointment. The main goal is to compare the effect on screening of pre-visit preparatory messages delivered in electronical versus printed format. Participants will be randomized to receive an e-LETTER (email linked to a personalized website), a traditional PRINT message or nothing (usual care-DC). Both interventions provide similar information, but the e-LETTER will contain hotlinks to additional resources. Participants will be equally likely to receive their electronic or print messages matched or mismatched to their attentional style (high v. low monitoring) as defined by the C-SHIP model. This randomized controlled trial has 4 aims: 1) To compare the effect of 2 delivery channels on CRC screening rates for women attending routine Ob/GYN visits; 2) To explore the moderating role of attentional style on the impact of the interventions; 3) To examine the mediating effect of cognitive-affective factors related to screening; 4) To investigate the cost-effectiveness of the interventions. Hypotheses include: 1) The e-LETTER will have a greater positive impact on screening rates than PRINT or UC; 2) Receipt of messages "matched" to attentional style will be more effective than "mismatched" messages; 3) Both interventions will improve cognitive-affective factors related to CRC screening; and 4) e-LETTER should prove most cost-effective due to its presumed fixed costs. CRC screening adherence will be assessed at 4 months. Psychosocial measures will be obtained at baseline, 4 and 12 months. It is predicted that e-LETTER, will produce the greatest increase in screening given its immediacy and greater accessibility to related informational links. PRINT messages will increase screening over UC. Receipt of messages matched to attentional style (e.g. low monitor receives low monitor message) will be more effective than mismatched messages. Finally, electronic interventions will be more cost-effective. In summary, this proposal compares the utility of web-based and printed educational interventions to increase CRC screening. Using the routine Ob/Gyn visit, the efficacy of tailored messages will be assessed. The e-LETTER potentially represents a dissemination channel for information that is rapid, user-friendly, and cost-effective. If successful, subsequent efforts could explore the effect of more elaborate Internet sites.