Evaluating a Tailored Intervention: METHODS part 2
Tailored Telephone Counseling
Health messages can be generic, targeted to subsets of the population or tailored for individual recipients. Tailored messages incorporate sociocul-tural and psychological factors that have been shown to increase compliance with health behavioral objectives and they have been examined in a variety of ways. Respondents who completed the community-based survey and agreed that we could call them a second time were randomly assigned to the intervention and comparison groups. Mature African-American and Latina women counselors were trained prior to study implementation to follow scripted telephone protocols. These protocols were designed to inform women of the recommended age to get regular screening mammogram, to assess their intentions to obtain mammograms within the next three months and to schedule screening mammograms for women who requested this service. The scripts were designed with input from the focus groups to allow counselors to identify and overcome barriers unique to each participant that kept her from getting a screening mammography. Trained study staff conducted barrier counseling by telephone and mailed intervention materials to all respondents in the intervention group (Table 2). The comparison group participants also received phone calls but only to inquire if they had received screening mammograms since the enrollment call. Project staff was careful not to conduct barrier counseling with the comparison group participants during this conversation.
Table 2. Intervention components
• Counseling regarding the importance of requesting healthcare providers to examine their breasts during office visits.
• Counseling regarding the importance of complying with mammography screening guidelines.
• Scheduling a low-cost or no-cost mammography appointment within six months for those who express an interest; others were asked to schedule an appointment with their healthcare provider and have a mammogram within six months.
• Mailing a hard copy of the mammography appointment at least two weeks before it is scheduled.
• Mailing a program letter, screening mammography brochure and a shower card within two weeks of counseling to all participants in the intervention group to reinforce the counseling messages regarding breast examinations.
A quality-control protocol with random call monitoring was implemented to assure that the intervention was delivered as intended. dutasteride hair loss
Cost-Effectiveness of Outreach Interventions
Whereas cost-effectiveness analyses were not conducted in this study, a plethora of such studies has been conducted on this topic in various settings to promote compliance with screening mammography these studies have concluded that tailored phone interventions and other methods of outreach are cost-effective in motivating noncompli-ant women to get screening mammograms.
The follow-up questionnaire was administered to both the intervention and comparison groups and took approximately five minutes to complete. It was designed to assess the extent to which participants obtained screening mammograms in the six-month postintervention period. We also inquired of their reasons for having or not having screening mammograms during this period and their perceptions of the intervention materials. revatio online
Follow-Up Telephone Interviews
Telephone interviews were successfully completed with the 354 of the 430 study participants (82.3%) at six-month follow-up. Seventy-six (17.7%) participants were lost to follow-up for a variety of reasons, including changing residents, disconnected telephones, refusing to participate further and death. This resulted in the completion of interviews with 185 of 219 (84.5%) participants in the intervention group and 169 of 211 (80.1%) participants in the comparison group.
Chi-squared tests revealed that variables associated with the loss to follow-up were race or ethnicity, education and who paid for the last mammogram.
African-American women (23.0%), respondents who were more educated (22.9%) and those who paid for their last mammogram (33.3%) were more likely to be among those lost to follow-up.
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Various statistical tests were used to analyze the database. Frequency distributions of sociodemo-graphics, attitudinal and behavioral practices were calculated. In addition to descriptive analyses, Chi-squared tests were conducted to determine associations between the dependent variable (obtaining screening mammograms at follow-up) and all potential covariates (independent variables). Although bivariate analyses are important, they do not reveal the degree to which each covariate is related to the dependent variable because many variables are often interrelated. Thus, multivariate analyses were conducted to assess the predictive power of each independent variable in determining the likelihood of obtaining mammograms. For this purpose, we use linear regression analyses. Thus, controlling for various characteristics, multivariate analyses allowed us to examine in detail the predictors of obtaining screening mammograms and whether higher or lower estimated coefficients have a significant impact on the outcome. Diagnostic tests were performed to assess multicollinearity among the independent variables. In addition, diagnostic tests were performed to evaluate goodness of fit and normality of the dependent variable as required for linear regressions. All analyses were performed using the Statistical Package for Social Science (SPSS version 12.0, 2004) and p values <0.05 were considered statistically significant.