Breast Cancer, the most common cancer in American women, is steadily increasing. Research demonstrates that early detection through breast cancer screening offers an effective weapon to combat mortality, but compliance with breast cancer screening is problematic. The proposed research will test the relative effectiveness of presence or absence of physician recommendation and telephone or in-person individualized counseling strategies delivered by nurses, in improving knowledge, beliefs, changes in cognitive stage of breast cancer screening behavior and compliance with mammography, clinical breast exam (CBE) and breast self-exam (BSE). A second objective includes analysis of cost and marginal cost- effectiveness of each intervention. The proposed research addresses limitations of past and current research by testing the efficacy and cost effectiveness of different interventions using a population of women known to benefit from screening (50 or older) and targeting only noncompliant women. Interventions build on previous work with counseling strategies that were found to be effective but labor intensive. In addition, the Transtheoretical Model of behavioral change has been incorporated into counseling interventions to specifically target individuals based upon their cognitive stage. Physician recommendation will also be tested for its independent or additive effect to individually tailored counseling. Variables will be measured using valid and reliable instruments. Self-report of mammography and CBE will be verified by medical records. A sample of women from a large health maintenance organization (HMO) who have not had mammography in the last two years will be randomly assigned to one of six groups. A 2X3 factorial design will include presence or absence of physician recommendation and no counseling, telephone counseling or in-person counseling. Both process and outcome evaluation are planned. A logistic regression model will be used to evaluate intervention main effects and interactions. Univariate and multivariate techniques are planned for secondary analysis. Traditional cost and marginal cost-effectiveness analyses are planned to answer the second major objective of cost- effectiveness. Conclusions will add to the knowledge base needed for nurses to increase breast cancer screening behaviors in the most efficacious and cost-effective manner.
