Using new communication technologies, it is not only possible but practical to collect individual-level data from large populations and use that information to tailor health messages to a specific person. This kind of computer-based, individually tailored communication has shown promise in helping people change a range of cancer-related behaviors. But in all tailored interventions tested to date, messages have been individualized on the basis of constructs like readiness to change and perceived barriers drawn from a handful of health behavior theories. While these variables are clearly important, they represent but one set of factors that may influence a person's motivation and ability to make behavioral changes. Moreover, they don't always apply equally well to people from diverse ethnic backgrounds, and they seldom take into account contextual or cultural factors that may directly influence the way a person processes health information. In this study, we seek to increase mammography adherence and fruit and vegetable consumption among 1,500 low-income African American women from 10 urban public health centers by tailoring cancer prevention materials not only on behavioral constructs, but also on four important attributes of African American culture: religiosity, collectivism, ethnic identity, and perception of time. Specifically, we will test in a randomized trial the effectiveness of a bi-monthly women's health magazine that is tailored based upon either: (1) behavioral constructs; (2) culturally-relevant constructs; or, (3) both types of constructs. Follow-up conducted at 1-, 6-, and 15-months post baseline will assess changes in mammography adherence, consumption of fruits and vegetables, and women's responses to the tailored magazines. There is substantial unmet need for effective cancer control programs in this underserved population, and preliminary evidence suggests tailoring may be especially effective among African Americans and those with low income. To reach its full potential for cancer prevention and control, tailored communication must evolve to consider a wider range of behavioral precursors, and to generate more compelling, culturally relevant materials.
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