title: A randomized comparison of print and web communication on colorectal cancer screening.
abstract: BACKGROUND
  New methods to enhance colorectal cancer (CRC) screening rates are needed. The web offers novel possibilities to educate patients and to improve health behaviors, such as cancer screening. Evidence supports the efficacy of health communications that are targeted and tailored to improve the uptake of recommendations.
  
  
  METHODS
  We identified unscreened women at average risk for CRC from the scheduling databases of obstetrics and gynecology practices in 2 large health care systems. Participants consented to a randomized controlled trial that compared CRC screening uptake after receipt of CRC screening information delivered via the web or in print form. Participants could also be assigned to a control (usual care) group. Women in the interventional arms received tailored information in a high- or low-monitoring Cognitive Social Information Processing model-defined attentional style. The primary outcome was CRC screening participation at 4 months.
  
  
  RESULTS
  A total of 904 women were randomized to the interventional or control group. At 4 months, CRC screening uptake was not significantly different in the web (12.2%), print (12.0%), or control (12.9%) group. Attentional style had no effect on screening uptake for any group. Some baseline participant factors were associated with greater screening, including higher income (P = .03), stage of change (P < .001), and physician recommendation to screen (P < .001).
  
  
  CONCLUSIONS
  A web-based educational intervention was no more effective than a print-based one or control (no educational intervention) in increasing CRC screening rates in women at average risk of CRC. Risk messages tailored to attentional style had no effect on screening uptake. In average-risk populations, use of the Internet for health communication without additional enhancement is unlikely to improve screening participation.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00459030.
authors.affiliation: Fox Chase Cancer Center, Philadelphia, PA 19111, USA. david.weinberg@fccc.edu
authors.forename: David S
authors.initials: DS
authors.lastname: Weinberg
authors.forename: Eileen
authors.initials: E
authors.lastname: Keenan
authors.forename: Karen
authors.initials: K
authors.lastname: Ruth
authors.forename: Karthik
authors.initials: K
authors.lastname: Devarajan
authors.forename: Michelle
authors.initials: M
authors.lastname: Rodoletz
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Bieber
mesh_terms: D001288:Attention; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D058015:Health Communication / Q000379:methods*; D006801:Humans; D020407:Internet; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic