title: The effect of a stage-matched and tailored intervention on repeat mammography(1).
abstract: BACKGROUND
  Our objective was to determine whether a tailored, stage-matched educational intervention, guided by the transtheoretical model (TTM), would increase rates of repeat-screening mammography. DESIGN SETTING/PARTICIPANTS: A total of 1324 women (N=1026 after attrition) aged 50 to 74 years were recruited from a staff-model health maintenance organization. Some of the women were not due for mammograms at the time of recruitment.
  
  
  METHODS
  Women were randomly assigned to one of three intervention conditions: Group 1, no educational materials (usual care); Group 2, standard materials; and Group 3, stage-matched/tailored materials. Women in Groups 2 and 3 received a mailed education packet after both a baseline and a follow-up telephone interview. All women in Group 2 received the same materials regardless of differences in baseline mammography-related attitudes and behaviors. Each woman in Group 3 received materials based on her stage of adoption for mammography and TTM constructs.
  
  
  RESULTS
  Using clinical records, repeat screening was defined as receipt of a second mammogram within 14 months after obtaining an initial postbaseline mammogram.
  
  
  RESULTS
  Women in Group 3 were more likely to obtain repeat-screening mammograms than women in Group 1 (44.2% vs 35.8%; adjusted rate ratio = 1.29, 95% confidence interval [CI]=1.11-1.46; adjusted rate difference = 0.06, 95% CI=-0.01-0.13). The screening percentage in Group 2 was intermediate (39.3%), and did not differ from either Group 3 or Group 1.
  
  
  CONCLUSIONS
  The effect of the stage-matched/tailored intervention was sustained for repeat screening, although no educational materials were delivered to coincide with the timing for a second mammogram. However, the stage-matched/tailored intervention was not sufficient to have a substantial impact on screening beyond the effect of standard educational materials. Future interventions may need to administer "booster" sessions to increase repeat screenings.
authors.affiliation: Department of Community Health, Center for Gerontology & Health Care Research, Brown University, Providence, RI 02912, USA. Melissa_Clark@brown.edu
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Clark
authors.forename: William
authors.initials: W
authors.lastname: Rakowski
authors.forename: Beverly
authors.initials: B
authors.lastname: Ehrich
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Rimer
authors.forename: Wayne F
authors.initials: WF
authors.lastname: Velicer
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Dube
authors.forename: Deborah N
authors.initials: DN
authors.lastname: Pearlman
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Peterson
authors.forename: Michael
authors.initials: M
authors.lastname: Goldstein
mesh_terms: D000368:Aged; D001294:Attitude to Health; D005260:Female; D015438:Health Behavior; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods