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.
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