title: A randomised controlled trial of personalised decision support delivered via the internet for bowel cancer screening with a faecal occult blood test: the effects of tailoring of messages according to social cognitive variables on participation.
abstract: BACKGROUND
  In Australia, bowel cancer screening participation using faecal occult blood testing (FOBT) is low. Decision support tailored to psychological predictors of participation may increase screening. The study compared tailored computerised decision support to non-tailored computer or paper information. The primary outcome was FOBT return within 12 weeks. Additional analyses were conducted on movement in decision to screen and change on psychological variables.
  
  
  METHODS
  A parallel, randomised controlled, trial invited 25,511 people aged 50-74 years to complete an eligibility questionnaire. Eligible respondents (n = 3,408) were assigned to Tailored Personalised Decision Support (TPDS), Non-Tailored PDS (NTPDS), or Control (CG) (intention-to-treat, ITT sample). TPDS and NTPDS groups completed an on-line baseline survey (BS) and accessed generic information. The TPDS group additionally received a tailored intervention. CG participants completed a paper BS only. Those completing the BS (n = 2270) were mailed an FOBT and requested to complete an endpoint survey (ES) that re-measured BS variables (per-protocol, PP sample).
  
  
  RESULTS
  FOBT return: In the ITT sample, there was no significant difference between any group (χ (2)(2) = 2.57, p = .26; TPDS, 32.5%; NTPDS, 33%; and CG, 34.5%). In the PP sample, FOBT return in the internet groups was significantly higher than the paper group (χ (2)(2) = 17.01, p < .001; TPDS, 80%; NTPDS, 83%; and CG, 74%). FOBT completion by TPDS and NTPDS did not differ (χ (2)(1) = 2.23, p = .13). Age was positively associated with kit return. Decision to screen: 2227/2270 of the PP sample provided complete BS data. Participants not wanting to screen at baseline (1083/2227) and allocated to TPDS and NTPDS were significantly more likely to decide to screen and return an FOBT than those assigned to the CG. FOBT return by TPDS and NTPDS did not differ from one another (OR = 1.16, p = .42). Change on psychosocial predictors: Analysis of change indicated that salience and coherence of screening and self-efficacy were improved and faecal aversion decreased by tailored messaging.
  
  
  CONCLUSIONS
  Online information resources may have a role in encouraging internet-enabled people who are uncommitted to screening to change their attitudes, perceptions and behaviour.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12610000095066.
authors.affiliation: Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia. carlene.wilson@flinders.edu.au.|Cancer Council South Australia, Eastwood, South Australia, Australia. carlene.wilson@flinders.edu.au.
authors.forename: Carlene J
authors.initials: CJ
authors.lastname: Wilson
authors.affiliation: Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia.|Cancer Council South Australia, Eastwood, South Australia, Australia.|Commonwealth Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia.
authors.forename: Ingrid Hk
authors.initials: IH
authors.lastname: Flight
authors.affiliation: School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Turnbull
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Australia.|School of Population Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Tess
authors.initials: T
authors.lastname: Gregory
authors.affiliation: Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.affiliation: Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia.
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Young
authors.affiliation: Commonwealth Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Zajac
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010043:Outcome and Process Assessment, Health Care; D057285:Precision Medicine / Q000379:methods*