Increasing mammography among women aged 40-74 by use of a stage-matched, tailored intervention.

BACKGROUND Tailoring is a promising technique for encouraging greater performance of health-related behaviors. Tailored interventions are designed to be more individualized to personal characteristics, in contrast to "standard" interventions where all participants receive the same materials. METHODS A total of N = 1864 women aged 40-74 were recruited from a staff model HMO and randomly assigned to one of three intervention groups: (a) No Educational Materials, (b) Standard Materials, and (c) Stage-Matched Materials. A provider-directed component was common across all three conditions. The Standard and Stage-Matched groups each received two mailed educational packets after baseline and follow-up telephone interviews. The Stage-Matched intervention was based on the Transtheoretical Model of behavior change. RESULTS Analyses of n = 1397 women (after all attrition) showed that receipt of mammography after the baseline interview was higher for the Stage-Matched group (63.6%) than for the No Materials group (54.9%; OR = 1.43, 95% CI = 1.10, 1.86). The Standard intervention group was intermediate (58. 5%). The Standard group did not differ from the No Materials group, but did differ from the Stage-Matched group in multivariate analysis. CONCLUSIONS Stage-matched, tailored materials may be a means to encourage screening mammography. Such interventions can be implemented by telephone and mail.

[1]  B. Rimer Mammography Use in the U.S.: Trends and the Impact of Interventions , 1994 .

[2]  W F Velicer,et al.  An expert system intervention for smoking cessation. , 1993, Patient education and counseling.

[3]  R. Coates,et al.  Effect of a cancer screening intervention conducted by lay health workers among inner-city women. , 1997, American journal of preventive medicine.

[4]  V. Strecher,et al.  Physicians' recommendations for mammography: do tailored messages make a difference? , 1994, American journal of public health.

[5]  N. Breen,et al.  Trends in cancer screening--United States, 1987 and 1992. , 1996, MMWR. Morbidity and mortality weekly report.

[6]  A M Stoddard,et al.  Confirmatory analysis of opinions regarding the pros and cons of mammography. , 1997, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[7]  A. Leitch,et al.  American Cancer Society guidelines for the early detection of breast cancer: Update 1997 , 1997, CA: a cancer journal for clinicians.

[8]  J. Prochaska,et al.  Stages and processes of self-change of smoking: toward an integrative model of change. , 1983, Journal of consulting and clinical psychology.

[9]  J P Fulton,et al.  Women's decision making about mammography: a replication of the relationship between stages of adoption and decisional balance. , 1993, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[10]  W. Rakowski,et al.  Cancer screening practices among women in a community health center population. , 1996, American journal of preventive medicine.

[11]  W. Rakowski,et al.  Stages of change and decisional balance for 12 problem behaviors. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[12]  S. Mcphee,et al.  Promoting cancer screening. A randomized, controlled trial of three interventions. , 1989 .

[13]  M. Hovell,et al.  Evaluation of a worksite mammography program. , 1993, American journal of preventive medicine.

[14]  J. Prochaska,et al.  Toward a Comprehensive Model of Change , 1986 .

[15]  M. Hargreaves,et al.  Breast and cervical cancer screening among low-income women: impact of a simple centralized HMO intervention. , 1996, Journal of the National Medical Association.

[16]  B A Miller,et al.  Recent trends in U.S. breast cancer incidence, survival, and mortality rates. , 1996, Journal of the National Cancer Institute.

[17]  P. Parsons,et al.  Health insurance and cancer screening among women. , 1994, Advance data.

[18]  Ruth Etzioni,et al.  Community organization to promote breast cancer screening among women ages 50-75. , 1995, Preventive medicine.

[19]  S. Fletcher,et al.  Prompting physicians for preventive procedures: a five-year study of manual and computer reminders. , 1990, American journal of preventive medicine.

[20]  V. Champion Beliefs about breast cancer and mammography by behavioral stage. , 1994, Oncology nursing forum.

[21]  W. Miller,et al.  Treating addictive behaviors : processes of change , 1986 .

[22]  D. Hosmer,et al.  Impact of a breast cancer screening community intervention. , 1993, Preventive Medicine.

[23]  Assessing elements of women's decisions about mammography. , 1992 .

[24]  Peter Dews,et al.  The effect of patient and physician reminders on use of screening mammography in a health maintenance organization: Results of a randomized controlled trial , 1996, Cancer.

[25]  J O Prochaska,et al.  Stages of change in the modification of problem behaviors. , 1992, Progress in behavior modification.

[26]  W. Rakowski,et al.  Screening mammography and constructs from the transtheoretical model: Associations using two definitions of the stages-of-adoption , 1996, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[27]  M. Hersen,et al.  Progress in Behavior Modification , 1983 .

[28]  B. Rimer,et al.  Evaluation of three methods for improving mammography rates in a managed care plan. , 1997, American journal of preventive medicine.

[29]  P. Gimotty,et al.  Promoting Screening Mammography in Inner-City Settings: A Randomized Controlled Trial of Computerized Reminders as a Component of a Program to Facilitate Mammography , 1994, Medical care.

[30]  P. Gimotty,et al.  Promoting screening mammography in inner-city settings. The sustained effectiveness of computerized reminders in a randomized controlled trial. , 1997, Medical care.