title: Tailored messages, external barriers, and women's utilization of professional breast cancer screening over time.
abstract: BACKGROUND
  The efficacy of tailored messages on women's utilization of professional breast screening over time has not been examined often or in combination with external barriers (e.g., costs and access). The objectives of this study were to test the effects of alternative messages on mammography and clinical breast examination (CBE) utilization over time and to examine the combined effects of such messages and external barriers.
  
  
  METHODS
  In a randomized, controlled trial, three message conditions were compared: no message (control group), recommendations about screening, or recommendations plus tailored discussion (on beliefs, feelings, costs, and access). Messages were delivered by advanced practice nurses over the telephone. Participants were women ages 51-80 years who had not had mammography in the prior 13 months. Outcome measures were women's mammography and CBE utilization 3-6 months postintervention (short-term follow-up) and 13-16 months after short-term follow-up (long-term follow-up).
  
  
  RESULTS
  Both messages promoted mammography and CBE utilization at short-term follow-up. Utilization increased over time in all groups. Mammography utilization was greater for the tailored-message group compared with the recommendations-only group at long-term follow-up. Messages and external barriers had combined effects (Ps < 0.01). Among participants with high external barriers, participants in the message conditions-especially the tailored message-had the highest screening rates; among participants with low barriers, screening rates were similar across conditions.
  
  
  CONCLUSIONS
  Clinicians can tailor discussions on beliefs, feelings, cost, and access about screening to promote professional breast screening over time, especially with women who have not had mammograms as recommended and who have external barriers to screening.
authors.affiliation: School of Nursing, University of Wisconsin-Madison, 53792, USA. drlauver@wisc.edu
authors.forename: Diane Ruth
authors.initials: DR
authors.lastname: Lauver
authors.forename: Lori
authors.initials: L
authors.lastname: Settersten
authors.forename: Janet H
authors.initials: JH
authors.lastname: Kane
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Henriques
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control / Q000523:psychology; D003365:Costs and Cost Analysis; D005260:Female; D006266:Health Education / Q000379:methods*; D006297:Health Services Accessibility; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged