Evaluating a Tailored Intervention: METHODS
The study was conducted over a four-year period between 1996 and 2000. Participants were recruited using Computer Assisted Telephone Interviewing (CATI) software and the random-digit-dialing (RDD) method during 1997 and 1998. An independent firm conducted the community-based RDD survey using methods previously described. Study eligibility criteria included living in the King/Drew Medical Center service area, having an operable telephone, being female >40 years old and not having had a screening mammogram in the past year. Phone calls to enroll participants were initiated to the prequalified sample approximately one year after the completion of the community-based RDD survey. Participants’ enrollment continued for six months and follow-up telephone calls were made over the subsequent six months. In summary, the timeline included a 13-month community-based RDD survey period; a 12-month planning and development preintervention period; a six-month study enrollment period; a six-month follow-up period; and an 11-month data analyses, reporting and dissemination period.
Intervention Theoretical Framework
The Adherence Model, an integrated theoretical approach, was used to conceptualize our research and to maximize the effectiveness of our intervention. This model incorporates elements of the Health Belief Model, the Theory of Planned Behavior, the Transtheoretical Model, the Social Learning Theory and the Prospect Theory. The Adherence Model emphasizes identifying barriers to mammography, overcoming those barriers and identifying support for adherence to mammography guidelines. discount flomax
The Health Belief Model holds that a person will take a health-related action if that person feels that a negative health consequence can be avoided. The Theory of Reasoned Action suggests that the most important determinant of a person’s behavior is behavior intent. The individual’s intention to perform a behavior is a combination of attitude toward performing that behavior and subjective norm. The Transtheoretical Model conceptualizes behavior around stages of change. These stages represent ordered categories along a continuum of motivational readiness to change a problem behavior. The Social
Learning Theory focuses on the learning that occurs within a social context. It considers that people learn from one another, including such concepts as observational learning, imitation and modeling. Finally, the Prospect Theory is an alternative theory of choice under conditions of risk and deviates from expected utility theory by addressing that people evaluate choices with respect to gains and losses from a reference point. They tend to overweigh losses with respect to comparable gains and engage in risk-averse behavior with respect to gain and risk-acceptant behavior with respect to losses. Elements from each of these theories were used to help guide our inquiry. Get smart and save money! Buy aricept drug online
A total of six focus groups (three with African-American and three with Latina women) were conducted in English and Spanish using similar protocols with each racial and ethnic group to insure that the intervention materials were culturally appropriate. Experienced facilitators conducted the focus groups and participants were given refreshments and $25 each. The focus groups protocols included an introduction of the facilitator and the participants; a discussion of the project; an exploration of the focus group participants’ knowledge, attitudes and beliefs about breast cancer; a discussion of the specific facts and figures about breast cancer among African Americans and Latinas; a discussion of what it would take for participants to have screening mammograms; and a discussion of counseling strategies to overcome various barriers to screening mammograms. The focus group facilitators also inquired about the appropriate length for the telephone intervention and asked the participants to review and comment on brochures that we anticipated using. Screening mammography brochures, in both English and Spanish, were selected and purchased. In addition, we collaborated with the Los Angeles Regional Coalition of the California Breast Cancer Early Detection Program that provided shower cards in English and Spanish.
A program letter was developed to thank the respondents for participating in the study. This letter served as a reminder for respondents of their earlier phone conversation with study staff about the importance of getting screening mammograms and what they said they would do. Shower cards and screening mammography brochures were included in the letter to all respondents in the intervention group. These cards and brochures were designed specifically for African-American and Latina women and describe in words and graphics how to conduct breast self-examinations. buy finasteride online
We offered to schedule low- or no-cost mammograms at three community-based sites that had agreed to provide them to study participants. These appointments were included in the letters sent to study participants who expressed an interest in this service.