The health care setting is an important channel for delivering cancer prevention interventions. However, the vast majority of effects to develop and evaluate physician-delivered cancer prevention interventions have focused on private practice/hospital settings, or those that serve mainly middle income, ethnically homogenous populations. Little research has been done to evaluate the effectiveness of these strategies in health care settings that provide care to ethnically and socioeconomically diverse populations. This study will be conducted in the health centers of Harvard Pilgrim Health Care (HPHC), a large group model HMO that provides an opportunity to: (1) evaluates the impact of the intervention in a managed care environment; and (2) test the intervention with diverse, working class populations that include individuals who have multiple behavioral risk factors for cancer. In keeping with the overall theme for this PO1, this study tests a comprehensive cancer prevention model that includes a focus on the social context of both health care settings and the patients they serve. The proposed study will evaluate a comprehensive strategy for intervening with diverse populations in the health center setting. A randomized controlled design will be used, in which health centers are the unit of analysis; health centers will be randomly assigned to either: (1) usual care; or (2) comprehensive intervention, which includes physician- delivered recommendations, an office-systems intervention, a motivation intervention delivered by community health educators, a family intervention, and linkage with community resources. Primary outcomes include fruit and vegetable intake, saturated fat intake, and physical activity. A theoretically-driven intervention protocol, guided by process objectives, insures standardization of implementation across centers. A detailed process evaluation will be conducted, and the extent of intervention implementation and patient participation measured. The process tracking system will assess costs associated with the intervention delivery. Involvement of a Community Advisory Board will maximize the linkages with and relevance for the target communities; inclusion of a Managed Care Expert Advisory Committee will maximize the feasibility and generalizability of the intervention. The intervention is designed to influence individual motivation and health behavior change, while simultaneously influencing agents of change (e.g. physician, family) in a way that is congruent with the organization setting of the health care settings. This project may serve as a model for future cancer prevention intervention efforts in health care settings.
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