Primary care providers are in a unique position to deliver preventive counseling and screening for cancer. Americans report visiting a physician an average of 5.3 times per year, and they view physicians as the most credible sources of health information. This study will test the efficacy of a comprehensive tailored medical practice intervention and a home-based patient intervention to (a) increase delivery of breast cancer screening tests, and (b) increase patient adoption of three health-related behaviors, smoking cessation, adoption of low fat/high fiber diet, and avoidance of ultraviolet radiation. This randomized intervention trial employs a 2 (standard practice intervention v. comprehensive tailored intervention) x 2 (home intervention v. no home intervention) x 4 (yearly repeated measures) design. Practices are randomly assigned to the standard v. comprehensive interventions, and patients are randomly assigned within practices to home intervention or control conditions. We will collaborate with Blue Cross/Blue Shield of Rhode Island, through its managed care program, to identify eligible primary care practices and patients within practices. The two experimental interventions will utilize the Transtheoretical Model of Change (TTM) as the basis for understanding individual behavior change. Individuals in the home intervention will receive a series of four personalized computer generated reports, along with self-help manuals, designed to facilitate their progress through stages of change for adoption of cancer prevention behaviors, while individuals in the no-home intervention will receive assessment only. Medical providers in the practice intervention condition will be trained to use the TTM to provide stage-matched counseling and other state-appropriate resources to their patients. The intervention practices will also receive a comprehensive office system intervention (e.g. office staff involvement, reminders, assessment and feedback) which is tailored to the office stage of adoption. The standard practice condition will receive only a self-guided manual on development of office systems to support cancer prevention activities. The office intervention is based on a combination of models for understanding the organizational process of change toward adoption of medical practice patterns. The cross-comparisons of the four randomized conditions in this study will allow us to examine whether the comprehensive medical practice intervention will outperform standard care while also examining the independent effects of a home-based intervention on patient outcomes. We will also assess whether the addition of a home-based intervention to a practice-based intervention enhances outcomes compared to either intervention alone.
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