This study is designed to examine the relative value of different self-reward strategies in the long-term maintenance of breast self-examination (BSE) practice among women trained to do BSE. These self-reward maintenance procedures will be implemented by breast screening educators coordinated through the Community BSP Office in a Florida community beginning Year 2 of the Program Project. The three self-reward maintenance conditions will be: (a) self-reward instructions and materials delivered at the end of the BSE training session with no monthly prompts to encourage their use; (b) self-reward suggestions delivered by the BSE Maintenance Coordinator through the mail each month contingent upon evidence of BSE performance; and (c) external, monetary rewards and self-reward suggestions delivered through the mail on an intermittent schedule contingent upon BSE practice. Subjects will be 1800 women who attend a community-based breast screening training session in the study site where community-based BSE training efforts are underway. Training groups will be randomly assigned to conditions urging a randomized block design for six months until 1800 women have been enrolled in the study. Subjects will receive their respective self-reward manipulation for one year, followed by a second year in which all external rewards and mailed monthly self-reward prompts will be withdrawn. BSE frequency and quality, and self-reward use will be assessed through a telephone survey of all women in the three conditions at one year following BSE training and again at two years following initial training. Additionally, for a sub-set of the women in each condition, proficiency will be assessed in personal interviews using silicone breast models at each of these two measurement times.
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