title: The efficacy of tailored print materials in promoting colorectal cancer screening: results from a randomized trial involving callers to the National Cancer Institute's Cancer Information Service.
abstract: In this large randomized trial among callers to the Cancer Information Service (CIS), tailored print materials were tested for efficacy in promoting colorectal cancer (CRC) screening (fecal occult blood test [FOBT], flexible sigmoidoscopy, or colonoscopy). All participants completed baseline interviews at the end of their usual service calls to the CIS, as well as short-term (6-month) and longer-term (14-month) telephone follow-up interviews. The study sample (n = 4,014) was restricted to English-speaking CIS callers 50 + years of age, who would be eligible for CRC screening at 14 months follow-up and did not call the CIS about CRC or CRC screening. Four experimental conditions were compared: a single untailored (SU) mailout of print material (the control condition); a single tailored (ST) mailout of print material; four (multiple) tailored (MT) mailouts of print materials spanning 12 months, all of which were tailored to information obtained at baseline; and four (multiple) retailored (MRT) mailouts also spanning 12 months, with retailoring of the print materials (mailouts 2, 3, and 4) based on updated information obtained from the 6-month follow-up interviews. Consistent with the main hypothesis of this trial, a significant linear trend across the SU, ST, MT, and MRT groups was found at 14 months (42%, 44%, 51%, and 48%, respectively, p = 0.05). Only for MT was there a significant difference compared with SU (p = 0.03) for the sample as a whole, while no differences were found for MT vs. MRT at 14 months. Significant moderator effects in the predicted direction were found among females, younger participants, and among those with a history of CRC screening, all of which involved the SU vs. MT MRT comparisons. Only among younger participants (ages 50-59) was there a difference between SU vs. ST at 14 months. Given these results, we conclude from this trial the following: (1) the MRT intervention failed to show added benefit beyond the MT intervention, (2) the significant intervention effects involving the MT and MRT conditions can be explained by tailoring and/or the longitudinal nature of both interventions, and (3) the most compelling evidence in support of tailoring was found for the ST condition among younger participants, where a significant need for interventions exists at the national level. Directions for future research are discussed in light of the results summarized above.
authors.affiliation: AMC Cancer Research Center, Denver, Colorado 80214, USA. marcusa@amc.org
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Marcus
authors.forename: Mondi
authors.initials: M
authors.lastname: Mason
authors.forename: Pam
authors.initials: P
authors.lastname: Wolfe
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Rimer
authors.forename: Isaac
authors.initials: I
authors.lastname: Lipkus
authors.forename: Victor
authors.initials: V
authors.lastname: Strecher
authors.forename: Richard
authors.initials: R
authors.lastname: Warneke
authors.forename: Marion E
authors.initials: ME
authors.lastname: Morra
authors.forename: Amy Reasinger
authors.initials: AR
authors.lastname: Allen
authors.forename: Sharon W
authors.initials: SW
authors.lastname: Davis
authors.forename: Amy
authors.initials: A
authors.lastname: Gaier
authors.forename: Carlan
authors.initials: C
authors.lastname: Graves
authors.forename: Karen
authors.initials: K
authors.lastname: Julesberg
authors.forename: Lynne
authors.initials: L
authors.lastname: Nguyen
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Perocchia
authors.forename: Jo Beth
authors.initials: JB
authors.lastname: Speyer
authors.forename: Doug
authors.initials: D
authors.lastname: Wagner
authors.forename: Chris
authors.initials: C
authors.lastname: Thomsen
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Bright
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007255:Information Services; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D011795:Surveys and Questionnaires; D014481:United States