A large burden of cancer morbidity and mortality is potentially preventable by changes in personal health practices. Health habit advice by primary care physicians, who provide basic health care to most Americans, holds great promise as a strategy to alter cancer-related health habits. However, previous limitations in primary care research methods and a lack of real world practice laboratories have limited understanding of: how and when primary care physicians address cancer-specific health habit advice; the content of the advice that is provided; the feasibility of incorporating effective health habit advice approaches into the competing demands of every day practice; and the effectiveness of the advice on patient behavior change. My career goal is to establish myself as an independent investigator and expert in multi-method approaches to cancer prevention and control research in primary care settings and to conduct rigorous cancer prevention research that has impact on health care policy and practice. The proposed Career Development Award in Cancer Prevention, Control and Population Sciences will integrate mentoring, training and focused research to meet 3 objectives: 1) to become a methods expert in the integration of quantitative and qualitative approaches to cancer prevention and control research in primary care settings, 2) to use these multi- method techniques to identify pragmatic approaches to integrating cancer-specific health habit advice among the competing demands of primary care practice, and 3) to evaluate the effect of physician-provided cancer-specific health habit advice on change in patient behavior. An integrated series of multimethod studies are planned. The first studies will identify pragmatic approaches used to integrate cancer-specific health habit advice into primary care practice through in-depth ethnographic study of two rich existing datasets and a new study of a nested sample of 10 exemplar physicians. The resultant discoveries will be used to develop a new grounded measure of health habit advice approaches used by primary care physicians. Based on the principles of the Transtheoretical Model, a measure of progression along a continuum of change that captures small but clinically meaningful change in patient behavior will be constructed as an outcome. These measures will be tested in a representative sample of primary care physicians and will support an application for a larger study to evaluate the effectiveness of cancer-specific health habit advice provided by community primary care clinicians. This integrated series of studies will provide important new insights into pragmatic and effective approaches used in current practice, and will identify opportunities for intervention to increase the frequency and effectiveness of cancer-specific health habit advice in primary care practice.
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