The proposed research submitted by Duke University Medical Center for implementation with members of Kaiser Permanente of North Carolina (a staff model HMO), and is part of a larger interactive grant aimed at increasing breast cancer screening among nonadherent women. The interactive collaborators include the Fred Hutchinson Cancer Research Center, State University of New York at Stonybrook, University of Massachusetts and University of California at Los Angeles. The overall aims of the interactive application are to compare the effectiveness of Barriers-Specific Telephone Counseling in five regions of the U.S. and to assess the cost-effectiveness of the intervention in increasing screening among nonadherent women. Duke Comprehensive Cancer Center and Kaiser Permanente will compare two tailored interventions for women -- tailored print vs. tailored telephone counseling -- compared to usual care. The interventions are based upon the same theoretical models (the Transtheoretical Model and the Health Belief Model) and use a similar approach to staging women and providing stage-based personalized responses. All physicians at Kaiser also will receive a supportive educational package to ensure standardization of the physician messages. Baseline telephone interviews will be conducted in year 1 to assess knowledge, beliefs and practices of nonadherent women. Follow-up interviews will be conducted with the cohort in the last quarter of year 4. The research focuses on the important question of how to motivate nonadherent women to participate in regular breast screening. There should be wide generalizability since the research is being conducted in five settings across the country with a range of comparisons across delivery settings and populations. Each grantee will include a substantial proportion of minority women.
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