DESCRIPTION (adapted from investigator's abstract): The goal of this project is
to evaluate the effectiveness and acceptability of a computer-based
telecommunications system for increasing of regular screening mammography among
women ages 50-74. The Telephone-Linked-Communications for Mammography Screening
(TLC-M) is designed to educate, advise and motivate women to have regular
screening mammograms. There will be two versions of the TLC-M: one for women
who are coming due for their annual screening mammogram ("pre-due" women) and a
second version for women who missed their annual mammogram and who are
"past-due" ("past-due" women). The TLC technology supporting TLC-M has been
successfully used to positively affect patient behavior in medication
compliance, diet and exercise. It uses real human voice to speak over the
telephone; the users communicate by using the touch tone keypad on their
telephones. TLC-M will consist of up to three automated telephone
conversations. The content of these conversations is based on the
Transtheoretical Model in which a women's readiness to obtain routine screening
mammograms is assessed. Depending upon the women's intention, barriers for
having mammography are identified and addressed.
In the proposed project, the investigators will (1) modify a current version of
TLC-M, (2) pretest and modify the system accordingly, and (3) conduct two
linked randomized controlled trials of the effectiveness of TLC-M in increasing
mammography rates in "pre-due" and "past-due" women. Eligible women will be
ages 50-74 and will have received a screening mammogram six months prior to
entering the study. The researchers will recruit 1,050 participants over 12
months from a general medical practice, using the computer system of an
affiliated radiology department to screen for potentially eligible women,
followed by a telephone and office interviews to determine final eligibility
and to collect baseline data. One month prior to their due date for annual
screening mammography, these women will receive a reminder letter to schedule a
mammogram. In addition, a random sample of 150 of them will use TLC-M. All
participants in this 'pre-due" intervention will be evaluated 4 months after
their intervention to determine whether they obtained a mammogram. Women who
received the letter only and who did not obtain a mammogram during the
observation period (estimated to be 360 [40 percent of 900]} will enter a
"past-due" reminder letter or to use TLC-M. Four months after the
interventions, participants will be evaluated to determine whether they had a
mammogram. Mammography rates will be determined and compared using logistic
regression to control for potential demographic, medical and behavioral
confounders. TLC-M users in both studies will be queried regarding their
satisfaction with TLC-M.
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