The proposed research is part of a larger interactive grant to increase breast screening in underscreened women. The overall aims of the interactive application are to compare the effectiveness of Barrier- Specific Telephone counseling in five regions of the country and to assess the cost-effectiveness of the intervention in increasing screening. RAND will compare the effectiveness of two counseling interventions, telephone and mail, in motivating low income white, black and Hispanic women to be screened at least once in two out of three years. The primary intervention (telephone) is based on the Trans-theoretical and Health Belief models and will stage women to provide stage-based personal responses. The second intervention (mail expands this staged approach to anticipate and address barriers most likely in low income women, i.e., cost and lack of a regular physician. A longitudinal cohort design will follow 3240 female religious organization (ROs) members age 50 and over for three years to compare the effectiveness and cost-effectiveness of these two interventions on regular screening and mammography. The cohort will be members of three RO groups (predominantly white, black, and Hispanic), which will be randomized into two treatment (48 ROs) and one control (24 ROs) groups. The interventions will be conducted by trained church members who will serve as peer counselors. The ROs identified for the study will be located in a 10 mile radius of the UCLA-County hospital and based in low income census tracts. This project focuses on the efficacy of using ROs to deliver health promotion programs to low income neighborhoods. Because this is a five site interactive grant, there will be important comparisons possible across delivery settings and populations. The RAND church-based urban project focuses entirely on low income women, 2/3 of whom are minorities.
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