title: From the bench to public health: population-level implementation intentions in colorectal cancer screening.
abstract: BACKGROUND
  Early detection of colorectal cancer (CRC) using fecal occult blood test (FOBT) reduces mortality, yet screening adherence remains low.
  
  
  OBJECTIVE
  Enhancing FOBT adherence in a field experiment, using Implementation Intentions (II) technique.
  
  
  METHODS
  Participants were randomly assigned to a standard care group or to II experimental group.
  
  
  METHODS
  A test kit was mailed to 29,833 HMO-insured members in two waves in 2011.
  
  
  METHODS
  eligible persons aged 50-74 who underwent the test the year before. A sample of 2200 participants was interviewed over the telephone for possible cognitive and background moderators.
  
  
  METHODS
  Leaflet attached to the test kit containing an "if-then" condition and planning instructions of when, where, and how.
  
  
  METHODS
  Test performance at 2 and 6 months following mailing of the test kit, retrieved from HMO's computerized database (2011-2012).
  
  
  RESULTS
  Adherence in the experimental group ranged 1.2%-6.6% higher than in the control group. Within 6 months of kits' mailing, test uptake for the two waves was 71.4% and 67.9% for experiment and control, respectively (χ(2)=40.58, p=0.0001). The difference remained significant after controlling for age, gender, marital status, and wave (OR=1.17, 95% CI=1.11, 1.23, p<0.0001). Test performance was related to cognitive and background variables. No interaction was found among cognitive or background variables and the intervention.
  
  
  CONCLUSIONS
  II technique is useful in increasing adherence to CRC screening, even in a mailed form rather than a face-to-face experimental situation. Mailed II is an inexpensive and effective method, applicable for public health.
authors: Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer. Electronic address: neter@ruppin.ac.il.
authors: Efrat
authors: E
authors: Neter
authors: Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa.
authors: Nili
authors: N
authors: Stein
authors: Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa.
authors: Ofra
authors: O
authors: Barnett-Griness
authors: Department of Community Medicine and Epidemiology, Carmel Medical Center and Faculty of Medicine, Technion, Haifa, Israel.
authors: Gad
authors: G
authors: Rennert
authors: Department of Community Medicine and Epidemiology, Carmel Medical Center and Faculty of Medicine, Technion, Haifa, Israel.
authors: Lea
authors: L
authors: Hagoel
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011177:Postal Service; D011634:Public Health