Promoting Regular Mammography Screening II. Results From a Randomized Controlled Trial in US Women Veterans

Background Few health promotion trials have evaluated strategies to increase regular mammography screening. We conducted a randomized controlled trial of two theory-based interventions in a population-based, nationally representative sample of women veterans. Methods Study candidates 52 years and ol...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 2008-03, Vol.100 (5), p.347-358
Main Authors: Vernon, Sally W., del Junco, Deborah J., Tiro, Jasmin A., Coan, Sharon P., Perz, Catherine A., Bastian, Lori A., Rakowski, William, Chan, Wen, Lairson, David R., McQueen, Amy, Fernandez, Maria E., Warrick, Cynthia, Halder, Arada, DiClemente, Carlo
Format: Article
Language:English
Subjects:
Adult
Aged
Analysis of Variance
Biological and medical sciences
Breast Neoplasms - mortality
Breast Neoplasms - prevention & control
Clinical outcomes
Clinical trials
Female
Gynecology. Andrology. Obstetrics
Health behavior
Health promotion
Humans
Logistic Models
Mammary gland diseases
Mammography
Mammography - statistics & numerical data
Mass Screening - methods
Mass Screening - statistics & numerical data
Medical sciences
Middle Aged
Patient Compliance
Patient Selection
Proportional Hazards Models
Registries
Reproducibility of Results
Research Design
Tumors
United States - epidemiology
Veterans
Veterans - statistics & numerical data
Women
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Summary:Background Few health promotion trials have evaluated strategies to increase regular mammography screening. We conducted a randomized controlled trial of two theory-based interventions in a population-based, nationally representative sample of women veterans. Methods Study candidates 52 years and older were randomly sampled from the National Registry of Women Veterans and randomly assigned to three groups. Groups 1 and 2 received interventions that varied in the extent of personalization (tailored and targeted vs targeted-only, respectively); group 3 was a survey-only control group. Postintervention follow-up surveys were mailed to all women after 1 and 2 years. Outcome measures were self-reported mammography coverage (completion of one postintervention mammogram) and compliance (completion of two postintervention mammograms). In decreasingly conservative analyses (intention-to-treat [ITT], modified intention-to-treat [MITT], and per-protocol [PP]), we examined crude coverage and compliance estimates and adjusted for covariates and variable follow-up time across study groups using Cox proportional hazards regression. For the PP analyses, we also used logistic regression. Results None of the among-group differences in the crude incidence estimates for mammography coverage was statistically significant in ITT, MITT, or PP analyses. Crude estimates of compliance differed at statistically significant levels in the PP analyses and at levels approaching statistical significance in the ITT and MITT analyses. Absolute differences favoring the intervention over the control groups were 1%–3% for ITT analysis, 1%–5% for MITT analysis, and 2%–6% for the PP analysis. Results from Cox modeling showed no statistically significant effect of the interventions on coverage or compliance in the ITT, MITT, or PP analyses, although hazard rate ratios (HRRs) for coverage were consistently slightly higher in the intervention groups than the control group (range for HRRs = 1.05–1.09). A PP analysis using logistic regression produced odds ratios (ORs) that were consistently higher than the corresponding hazard rate ratios for both coverage and compliance (range for ORs = 1.15–1.29). Conclusions In none of our primary analyses did the tailored and targeted intervention result in higher mammography rates than the targeted-only intervention, and there was limited support for either intervention being more effective than the baseline survey alone. We found that adjustment for variable
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/djn026