title: Intervention Mediators in a Randomized Controlled Trial to Increase Colonoscopy Uptake Among Individuals at Increased Risk of Familial Colorectal Cancer.
abstract: BACKGROUND
  Understanding the pathways by which interventions achieve behavioral change is important for optimizing intervention strategies.
  
  
  OBJECTIVE
  We examined mediators of behavior change in a tailored-risk communication intervention that increased guideline-based colorectal cancer screening among individuals at increased familial risk.
  
  
  METHODS
  Participants at increased familial risk for colorectal cancer (N = 481) were randomized to one of two arms: (1) a remote, tailored-risk communication intervention (Tele-Cancer Risk Assessment and Evaluation (TeleCARE)) or (2) a mailed educational brochure intervention.
  
  
  RESULTS
  Structural equation modeling showed that participants in TeleCARE were more likely to get a colonoscopy. The effect was partially mediated through perceived threat (β = 0.12, p < 0.05), efficacy beliefs (β = 0.12, p < 0.05), emotions (β = 0.22, p < 0.001), and behavioral intentions (β = 0.24, p < 0.001). Model fit was very good: comparative fit index = 0.95, root-mean-square error of approximation = 0.05, and standardized root-mean-square residual = 0.08.
  
  
  CONCLUSIONS
  Evaluating mediating variables between an intervention (TeleCARE) and a primary outcome (colonoscopy) contributes to our understanding of underlying mechanisms that lead to health behavior change, thus leading to better informed and designed future interventions.
  
  
  BACKGROUND
  ClinicalTrials.gov , NCT01274143.
authors.affiliation: Department of Individual, Family, & Community Education, University of New Mexico, Albuquerque, NM, USA. BBrumbach@unm.edu.
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Brumbach
authors.affiliation: Department of Psychology, Brigham Young University, Provo, UT, USA.
authors.forename: Wendy C
authors.initials: WC
authors.lastname: Birmingham
authors.affiliation: Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Watcharaporn
authors.initials: W
authors.lastname: Boonyasiriwat
authors.affiliation: Department of School of Public Health Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, TX, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Walters
authors.affiliation: University of New Mexico Comprehensive Cancer Center, Division of Epidemiology, Biostatistics, and Prevention, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Kinney
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000523:psychology*; D055088:Early Detection of Cancer / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010353:Patient Education as Topic / Q000379:methods*; D055815:Young Adult
keywords: Colonoscopy; Colorectal cancer screening; Extended parallel process model; Implementation-intention strategies; Structural equation modeling