Screening Self-efficacy Research Articles

Abstract B11: Sustaining annual colorectal cancer screening in rural community health clinics using the fecal immunochemical test (FIT)

Abstract Introduction: Colorectal cancer (CRC), the second leading cause of cancer death in the United States, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low-income individuals, adults with low literacy, and those living in rural areas. These groups all have screening completion rates below 50%. Objectives: To assess patient knowledge, beliefs, and self-efficacy about CRC screening and compare the effectiveness of two health literacy informed telephone follow-up strategies to improve annual screening over a three-year period with fecal immunochemical test (FIT) in rural community clinics. Methods: A two-arm, randomized controlled trial is being implemented in four community clinics. Clinics reported CRC baseline screening rates of 3% to 5%. Eligible patients, age 50-75, were recruited at the clinic prior to a scheduled appointment. A research assistant (RA) conducted a baseline structured interview measuring CRC screening knowledge, beliefs, and self-efficacy. The RA then recommended screening and gave brief literacy and culturally appropriate education using a pamphlet (4th-grade level), the FIT kit with preaddressed envelope, simplified instructions (3rd-grade level), and a demonstration of how to use it. At four weeks patients who had not returned their kit received either 1) a personal follow-up call (PC) from a central prevention coordinator using motivational interviewing skills and reminding them to complete and mail FIT kits, or 2) an automated follow-up call (AC) using plain language and motivational messages encouraging patients to complete and mail the FIT. Outcomes include FIT completion after intervention, and again at 12 and 24 months. Results: 620 patients not up to date with screening were enrolled: 64% African American, 56% women, 40% inadequate literacy. Although 90% reported having heard of CRC, only 64% knew a test to check for CRC. 70% reported that a provider had recommended CRC screening in the past and 91% reported they would want to know if they have CRC. Self-efficacy was high, with over 90% indicating they would return the kit to the lab. Screening results: 620 patients enrolled (AC: n=308 / PC: n=306); 418 (68%) completed tests (AC: n=213 (69%) / PC: n=205 (67%)). Follow-up calls for unreturned kits--AC: 124 (40%) people called--29 returned FIT (9.4% of people called completed FIT). PC: 127 (41%) people called--26 returned FIT (9.4% of people called completed FIT). 2nd-year screening: 255 second kits mailed out to date (AC: n=128/PC: n=125); 98 (38.5%) completed tests (AC: n=49 (38%) / PC: n=49 (39%)). Follow-up calls for unreturned kits--AC: 89 (70%) people called—19 returned FIT (14.8% of people called completed FIT). PC: 82 (66%) people called—17 returned FIT (13.6% of people called completed FIT). Discussion: Implementing health literacy influenced CRC education, and screening strategies using the FIT and phone reminders dramatically increased FIT completion in rural community clinics. The less costly and time-consuming automated call was equally effective as a personal call. Citation Format: Connie L. Arnold, Terry C. Davis, Alfred Rademaker, James Morris, Glenn Mills. Sustaining annual colorectal cancer screening in rural community health clinics using the fecal immunochemical test (FIT) [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B11.

Ko-Pamoja: the feasibility of a lay health educator-led breast and cervical screening program for Black women in Ontario, Canada (short report).

Effective strategies are needed to actively encourage Black women inCanada to adhere to breast and cervical cancer screening and follow-up. In this study, we describe "Ko-Pamoja," a pilot peer education program for breast and cervical cancer screening targeted specifically at Black women in Toronto, Canada. We used an Afrocentric lens to design the program, whose purpose was to increase awareness of cancer susceptibility and the benefits of screening for breast and cervical cancer for Black women. Participants were recruited through three Black-predominant churches. We used pre- and post-session questionnaires to assess changes in participant awareness of cancer susceptibility and screening guidelines, and changes in screening self-efficacy. 30 women attended sessions. Ko-Pamoja was able to increase awareness of cancer susceptibility, awareness of screening guidelines, and screening self-efficacy. Two months after the last session, four women had been screened for breast cancer at a participating mammogram site. Building on the successes of Ko-Pamoja, future versions are being developed in the region. These versions will be adapted to take into account our lessons learned while maintaining the Afrocentric lens and community-focussed approach, in order to promote cancer screening and ultimately improve outcomes.

Abstract 770: Colorectal cancer screening in rural community health clinics using the fecal immunochemical test (FIT)

Abstract Introduction: Colorectal cancer (CRC), the second leading cause of cancer death in the United States, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low income individuals, adults with low literacy and those living in rural areas. These groups all have screening completion rates below 50%. Objectives: To assess patient knowledge, beliefs, and self-efficacy about CRC screening and compare the effectiveness of two health literacy informed telephone follow-up strategies to improve initial and annual repeat screening with Fecal Immunochemical Test (FIT) in rural community clinics. Methods: A two-arm, randomized controlled trial is being implemented in four community clinics. Clinics reported CRC baseline screening rates of 1% to 3%. Eligible patients, age 50-75, are recruited at the clinic prior to a scheduled appointment. A research assistant (RA) conducts a baseline structured interview measuring CRC screening knowledge, beliefs, and self-efficacy. The RA then recommends screening and gives brief literacy and culturally appropriate education using a pamphlet (4th grade level), the FIT kit with pre-addressed envelope, simplified instructions (3rd grade level) and a demonstration of how to use it, At four weeks patients who have not returned their kit receive either 1) a personal follow-up call (PC) from a central prevention coordinator using motivational interviewing skills and reminding them to complete and mail FIT kits; or 2) an automated follow-up call (AC) using plain language and motivational messages encourages patients to complete and mail the FIT. Outcomes include FIT completion after intervention, and again at 12 and 24 months. 650 patients will be enrolled. Results: To date 599 patients not up-to-date with screening have been enrolled; 64% African American, 56% women; 40% inadequate literacy. Although 90% reported having heard of CRC, only 64% knew a test to check for CRC. 70% reported a provider had recommended CRC screening in the past and 91% reported they would want to know if they have CRC. Self-efficacy was high with over 90% indicating they would return the kit to the lab. Screening results: 599 patients enrolled to date (AC: n=300 / PC: n=299); 412 (69%) completed tests (AC: n=210 (70%) / PC: n=202 (68%)). Follow-up calls for Unreturned Kits - AC: 113 people called - 26 returned FIT (23% of people called completed FIT). PC: 115 people called - 22 returned FIT - (19% of people called completed FIT). 2nd Year Screening: 129 Second kits mailed out to-date. AC (n=61): n=29 (48%) completed kits. PC (n=68): 28 (41%) completed kits. Discussion: Implementing literacy and culturally appropriate CRC education and screening strategies using the FIT and phone reminders has the potential to increase CRC screening rural community clinics and address public health disparities. Citation Format: Connie L. Arnold, Terry C. Davis, Alfred W. Rademaker, James Morris, Glenn Mills. Colorectal cancer screening in rural community health clinics using the fecal immunochemical test (FIT) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 770. doi:10.1158/1538-7445.AM2017-770

Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women.

Jailed women are four-five times more likely to have had cervical cancer compared to women without criminal justice histories. Previous research has shown that an important contributor to cervical cancer risk, and perhaps lack of follow-up, is incarcerated women's low health literacy about broader reproductive health issues. Little work has been done to address this disparity. Thus, the objective of this study was to test the effectiveness of an intervention to improve incarcerated women's cervical health literacy and ultimately address cervical cancer disparities. Using a waitlist control design, we compared changes in cervical health literacy (knowledge, beliefs, self-efficacy, and confidence for screening and follow-up) among 188 incarcerated women who completed a 10-hour intervention between 2014 and 2016 in three Kansas City jails. We used bivariate tests and multivariate analyses that controlled for baseline cervical health literacy level and key covariates. Women in the intervention group showed significant gains in seven out of eight cervical health literacy domains (all p < 0.01), whereas the control group only improved in one domain (p < 0.01). When controlling for covariates, the intervention group had less barriers, perceptions of seriousness, susceptibility to disease, and increased self-efficacy for cervical health screening and follow-up, compared to the control group (all p < 0.05). A brief intervention is an effective way to improve jailed women's cervical health literacy, but should be provided alongside systemic efforts that expand access to correctional preventive health services, including the human papillomavirus vaccine, community-based cancer screenings, and health insurance after women leave jails and transition back to communities.

ECHO Autism

Children with autism spectrum disorder (ASD) have complex medical problems, yet they are at high risk for unmet health care needs. Primary care providers are perfectly positioned to meet these needs; however, they often lack training in ASD. This pilot project developed and tested a new model for training primary care providers in best-practice care for ASD using the Extension for Community Healthcare Outcomes (ECHO) framework. The 6-month ECHO Autism pilot project consisted of 12 biweekly clinics focused on screening and identification of ASD symptoms and management of medical and psychiatric comorbidities. Participants completed measures of practice behavior and self-efficacy in screening and management of children with ASD at baseline (pretest) and after 6 months of ECHO Autism (posttest). Statistically significant improvements were observed in self-efficacy, in adherence to ASD screening guidelines, and in use of ASD-specific resources. Participants also reported high satisfaction with the program.

Beyond a Paycheck: The Influence of Workforce Participation on Women’s Cancer Screening in Turkey

The present study investigates the influence of workforce participation on women’s cancer screening behaviors in Turkey. In cultures with predominantly Muslim populations like Turkey, emphasis is typically placed on a woman’s traditional role as a child bearer. Although the impact of workforce participation on women’s welfare has been studied in various contexts, the relationship between workforce participation and health protective behavior has received scant attention. Using quantitative data from a survey of women aged 40 and above from 33 urban cities in Turkey (N = 483), we examine the influence of workforce participation on breast and cervical cancer screening behaviors. Homemakers were less likely than working/retired women to be up-to-date on screenings. Women with lower income and education screened less; however, workforce participation seemed to have a positive effect on screening among these women. Additionally, working/retired women and homemakers differed from each other in terms of their perceptions regarding their risk of developing cancer (perceived susceptibility). In addition, both perceived susceptibility and women's perceptions regarding their ability to get cancer screening (self-efficacy) were significant predictors of intention to engage in screening in future. In Turkey, homemakers are in a vulnerable position due to lower rates of cancer screening. Furthermore, targeting homemakers for interventions may be easier than trying to identify other low screening groups of women such as those with lower education or income. Interventions raising perceptions of susceptibility to cancer, possibly by targeting neighborhoods during working hours, could be useful in increasing screening rates at risk women.

Salud es Vida: a Cervical Cancer Screening Intervention for Rural Latina Immigrant Women.

This study examined the feasibility and efficacy of Salud es Vida-a promotora-led, Spanish language educational group session on cervical cancer screening (Pap tests)-self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among immigrant Hispanic/Latina women from farmworker backgrounds. These women are disproportionately burdened with cervical cancer, with mortality rates significantly higher than non-Hispanic whites. The two-arm, quasi-experimental study was conducted in four rural counties of Southeast Georgia in 2014-2015. Hispanic/Latina immigrant women aged 21-65years and overdue for a Pap test were included as intervention (N = 38) and control (N = 52) group participants. The intervention was developed in partnership with a group of promotoras to create the toolkit of materials which includes a curriculum guide, a brochure, a flipchart, a short animated video, and in-class activities. Twelve (32%) intervention group participants received the Pap test compared to 10 (19%) control group participants (p = 0.178). The intervention group scored significantly higher on both cervical cancer knowledge recall and retention than the control group (p < 0.001). While there was no statistically significant difference in cervical cancer screening self-efficacy scores between the group participants, both groups scored higher at follow-up, adjusting for the baseline scores. The group intervention approach was associated with increased cervical cancer knowledge but not uptake of Pap test. More intensive interventions using patient navigation approaches or promotoras who actively follow participants or conducting one-on-one rather than group sessions may be needed to achieve improved screening outcomes with this population.

Abstract B12: To screen or not to screen: Examining components of the Extended Parallel Process Model in a tailored-risk communication intervention to promote colorectal cancer screening

Abstract The Extended Parallel Process Model (EPPM) has been effectively used to promote healthy behaviors, but less is known about the effectiveness of the EPPM in promoting screening adherence in individuals at familial risk for colorectal cancer (CRC). The original EPPM model posits that an additive relationship exists between the constructs perceived severity and susceptibility (“threat”) and between perceived self- and response efficacy (“efficacy”). However, this model may not be as effective in predicting message acceptance in the context of CRC screening as these constructs may independently contribute to the model. For example, with CRC threat, there may be little variance in the perceived severity score as perceptions of cancer severity have been shown to be universally high. Likewise, one may have high levels of response efficacy (“Colonoscopy can save my life”) but low self-efficacy (“Without insurance I can't pay for a colonoscopy”) thus influencing efficacy scores. To determine the effectiveness of the EPPM in promoting CRC screening, we used data from the Family Colorectal Cancer Awareness and Risk Education Project (Family CARE), that tested a remote tailored-risk communication intervention aimed at individuals with familial risk for CRC. Intention-to-screen and medical record-verified colonoscopy (CS) were collected on 218 participants who received the personalized intervention. Using structural equation modeling (SEM), we examined associations of CRC threat and efficacy with greater message acceptance in a full additive model, and in an apriori alternative model in which perceived severity, susceptibility, self-efficacy and response efficacy acted as independent predictors. We considered indicators of good fit to be Root Mean Square Error of Approximation (RMSEA) &amp;lt;.08, Standardized Root Mean Residual (SRMR) &amp;lt;.08, and Comparative Fit Index (CFI) &amp;gt;.90. We compared the two models based on model fit indices, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC), with the preferred model having lower AIC and BIC. SEM results indicated poor fit for the full additive EPPM model (RMSEA=0.109; SRMR=0.137; CFI 0.800) while the alternative model showed good fit (RMSEA=0.068; SRMR=0.063; CFI=0.933). Additionally, comparison of the two models indicated that the alternative model was a better fit than the full additive model (RMSEA=0.071; SRMR=0.108; CFI 0.918; AIC=11021; BIC=11332). Further, we found perceptions of susceptibility (B =0.321, p &amp;lt;.001) and self-efficacy (B=0.365, p&amp;lt;0.001) to be significantly associated with intention to screen, while severity (B=0.059, p=0.454) and response efficacy (B=-0.189, p=0.101) showed no significant association. Importantly, intention to screen was significantly associated with medically verified CS behavior (B=0.728, p&amp;lt;0.001). Relatives of CRC patients are at increased risk for the disease, yet screening rates remain low among these individuals despite the effectiveness of CS in both early detection and cancer prevention. Theory-based communication such as the EPPM that addresses multiple determinates of behavior may help promote CRC screening yet few studies have tested conceptual models with regard to an intervention's effect on psychosocial pathways and actual cancer screening behavior. Our results indicate that focusing on individuals' perceptions of CRC susceptibility and screening self-efficacy may more effectively contribute to CRC screening behavior. Noteworthy, we measured both intentions to screen and actual screening behavior. These findings uniquely contribute to the literature by providing evidence of the underlying theoretical psychosocial pathways of how a personalized health promotion intervention works in motivating CRC screening among individuals at increased familial risk. Citation Format: Wendy C. Birmingham, Man Hung, Watcharaporn Boonyasiriwat, Scott T. Walters, Antoinette M. Stroup, Marc D. Schwartz, Jeremy D. Franklin, Anita Y. Kinney. To screen or not to screen: Examining components of the Extended Parallel Process Model in a tailored-risk communication intervention to promote colorectal cancer screening. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr B12.

The Effects of Tailoring Knowledge Acquisition on Colorectal Cancer Screening Self-Efficacy

Interventions tailored to psychological factors such as personal and vicarious behavioral experiences can enhance behavioral self-efficacy but are complex to develop and implement. Information seeking theory suggests tailoring acquisition of health knowledge (without concurrent psychological factor tailoring) could enhance self-efficacy, simplifying the design of tailored behavior change interventions. To begin to examine this issue, the authors conducted exploratory analyses of data from a randomized controlled trial, comparing the effects of an experimental colorectal cancer screening intervention tailoring knowledge acquisition with the effects of a nontailored control on colorectal cancer screening knowledge and self-efficacy in 1159 patients comprising three ethnicity/language strata (Hispanic/Spanish, 23.4%, Hispanic/English, 27.2%, non-Hispanic/English, 49.3%) and 5 recruitment center strata. Adjusted for study strata, the mean postintervention knowledge score was significantly higher in the experimental group than in the control group. Adjusted experimental intervention exposure (B = 0.22, 95% CI [0.14, 0.30]), preintervention knowledge (B = 0.11, 95% CI [0.05, 0.16]), and postintervention knowledge (B = 0.03, 95% CI [0.01, 0.05]) were independently associated with subsequent colorectal cancer screening self-efficacy (p < .001 all associations). These exploratory findings suggest that tailoring knowledge acquisition may enhance self-efficacy, with potential implications for tailored intervention design, but this implication requires confirmation in studies specifically designed to examine this issue.

Socio-psychological factors in the Expanded Health Belief Model and subsequent colorectal cancer screening

ObjectiveCRC screening interventions tailored to the Expanded Health Belief Model (EHBM) socio-psychological factors have been developed, but the contributions of individual factors to screening outcomes are unclear. MethodsIn observational analyses of data from a randomized intervention trial, we examined the independent associations of five EHBM factors – CRC screening knowledge, self-efficacy, stage of readiness, barriers, and discussion with a provider – with objectively measured CRC screening after one year. ResultsWhen all five factors were added simultaneously to a base model including other patient and visit characteristics, three of the factors were associated with CRC screening: self-efficacy (OR=1.32, p=0.001), readiness (OR=2.72, p<0.001), and discussion of screening with a provider (OR=1.59, p=0.009). Knowledge and barriers were not independently associated with screening. Adding the five socio-psychological factors to the base model improved prediction of CRC screening (area under the curve) by 7.7%. ConclusionPatient CRC screening self-efficacy, readiness, and discussion with a provider each independently predicted subsequent screening. Practice implicationsSelf-efficacy and readiness measures might be helpful in parsimoniously predicting which patients are most likely to engage in CRC screening. The importance of screening discussion with a provider suggests the potential value of augmenting patient-focused EHBM-tailored interventions with provider-focused elements.

Implementation intentions and colorectal screening: a randomized trial in safety-net clinics.

Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups. The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics. Randomized controlled trial. Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited. The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy). The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013). The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening. The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.

Predictors of Stage of Adoption for Colorectal Cancer Screening Among African American Primary Care Patients

Compared with other racial groups, African Americans have the highest colorectal cancer (CRC) incidence and mortality rates coupled with lower screening rates. Our study examined the predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy among African American primary care patients who were nonadherent to published screening guidelines. Baseline data (N = 815) in a randomized clinical trial were analyzed. Participants were categorized into precontemplation, contemplation, and preparation stages for FOBT and colonoscopy. Predictor variables were demographics, clinical variables, CRC health beliefs and knowledge, and social support. Hierarchical modeling was to identify significant predictors of stage of adoption. Older, male, Veterans Affairs participants and those with higher perceived self-efficacy, family/friend encouragement, and a provider recommendation had higher odds of being at a more advanced stage of adoption for FOBT. Patients with a history of cancer and higher perceived barriers had higher odds of being at an earlier stage of adoption for FOBT. Predictors of more advanced stage of adoption for colonoscopy included higher perceived benefits, higher perceived self-efficacy, family/friend encouragement, and a provider recommendation for colonoscopy. Higher income (>30 000 vs <15 000) was predictive of earlier stage of adoption for colonoscopy. Enhancing self-efficacy, encouragement from family and friends, and provider recommendations are important components of interventions to promote CRC screening. Nurses can use knowledge of the characteristics associated with stage of adoption to educate and motivate their African American primary care patients to complete CRC screening tests.

Sociopsychological tailoring to address colorectal cancer screening disparities: a randomized controlled trial.

Interventions tailored to sociopsychological factors associated with health behaviors have promise for reducing colorectal cancer screening disparities, but limited research has assessed their impact in multiethnic populations. We examined whether an interactive multimedia computer program (IMCP) tailored to expanded health belief model sociopsychological factors could promote colorectal cancer screening in a multiethnic sample. We undertook a randomized controlled trial, comparing an IMCP tailored to colorectal cancer screening self-efficacy, knowledge, barriers, readiness, test preference, and experiences with a nontailored informational program, both delivered before office visits. The primary outcome was record-documented colorectal cancer screening during a 12-month follow-up period. Secondary outcomes included postvisit sociopsychological factor status and discussion, as well as clinician recommendation of screening during office visits. We enrolled 1,164 patients stratified by ethnicity and language (49.3% non-Hispanic, 27.2% Hispanic/English, 23.4% Hispanic/Spanish) from 26 offices around 5 centers (Sacramento, California; Rochester and the Bronx, New York; Denver, Colorado; and San Antonio, Texas). Adjusting for ethnicity/language, study center, and the previsit value of the dependent variable, compared with control patients, the IMCP led to significantly greater colorectal cancer screening knowledge, self-efficacy, readiness, test preference specificity, discussion, and recommendation. During the followup period, 132 (23%) IMCP and 123 (22%) control patients received screening (adjusted difference = 0.5 percentage points, 95% CI -4.3 to 5.3). IMCP effects did not differ significantly by ethnicity/language. Sociopsychological factor tailoring was no more effective than nontailored information in encouraging colorectal cancer screening in a multiethnic sample, despite enhancing sociopsychological factors and visit behaviors associated with screening. The utility of sociopsychological tailoring in addressing screening disparities remains uncertain.

Individual and Community Effectiveness of a Cervical Cancer Screening Program for Semi-Urban Mexican Women

The effectiveness at the individual and community level of an educational intervention to increase cervical cancer screening self-efficacy among semi-urban Mexican women was evaluated and changes in reported community barriers were measured after the intervention was implemented. The educational intervention was evaluated with a quasi-experimental pre-test/post-test design and a control group, based on the Integrative Model of Behavior Prediction and AMIGAS project materials. For the intervention group, increased self-efficacy increased requests to obtain a Pap (p < 0.05). Barriers to obtaining a Pap were embarrassment and lack of time at the individual level, and lack of time, test conditions and fear of social rejection in the community's cultural domain. At both the individual and community levels, having more information about the test and knowing it would be performed by a woman were primary facilitators. Few women used medically precise information when referring to the Pap and cervical uterine cancer. Although the level of self-efficacy of the participants increased, barriers in the health system affect the women's perceived ability to get a Pap. Better care for users is needed to increase consistent use of the test. The study shows the importance of using culturally adapted, multilevel, comprehensive interventions to achieve successful results in target populations.

Physicians' attitudes toward unhealthy alcohol use and self-efficacy for screening and counseling as predictors of their counseling and primary care patients' drinking outcomes.

ObjectivePatients’ unhealthy alcohol use is often undetected in primary care. Our objective was to examine whether physicians’ attitudes and their perceived self-efficacy for screening and counseling patients is associated with physicians’ counseling of patients with unhealthy alcohol use, and patients’ subsequent drinking.MethodsThis study is a prospective cohort study (nested within a randomized trial) involving 41 primary care physicians and 301 of their patients, all of whom had unhealthy alcohol use. Independent variables were physicians’ attitudes toward unhealthy substance use and self-efficacy for screening and counseling. Outcomes were patients’ reports of physicians’ counseling about unhealthy alcohol use immediately after a physician visit, and patients’ drinking six months later.ResultsNeither physicians’ attitudes nor self-efficacy had any impact on physicians’ counseling, but greater perceived self-efficacy in screening, assessing and intervening with patients was associated with more drinking by patients six months later.ConclusionsFuture research needs to further explore the relationship between physicians’ attitudes towards unhealthy alcohol use, their self-efficacy for screening and counseling and patients’ drinking outcomes, given our unexpected findings.

Racial/Ethnic Variations in Colorectal Cancer Screening Self-Efficacy,Fatalism and Risk Perception in a Safety-Net Clinic Population: Implications for Tailored Interventions

Ethnic and racial minority groups in the U.S. receive fewer colorectal cancer (CRC) screening tests and are less likely to be up-to-date with CRC screening than the population as a whole. Access, limited awareness of CRC and barriers may, in part, be responsible for inhibiting widespread adoption of CRC screening among racial and ethnic minority groups. The purpose of this study was to examine the role of self-efficacy, fatalism and CRC risk perception across racial and ethnic groups in a diverse sample. This study was a cross-sectional analysis from baseline measures gathered on a group of patients recruited into a trial to track colorectal cancer screening in underserved adults over 50. Out of 470 Participants, 42% were non-Hispanic; 27% Hispanic and 28% non-Hispanic White. Hispanic and non-Hispanic Blacks were more likely to have fatalistic beliefs about CRC than non-Hispanic Whites. Non-Hispanic Blacks perceived higher risk of getting colon cancer. Self-efficacy for completing CRC screening was higher among Non-Hispanic Blacks than among Hispanics. Racial and ethnic differences in risk perceptions, fatalism and self-efficacy should be taken into consideration in future CRC interventions with marginalized and uninsured populations.

Testing a Spanish-language colorectal cancer screening decision aid in Latinos with limited English proficiency: results from a pre-post trial and four month follow-up survey.

BackgroundCompared with non-Latinos, Latinos in the US have low rates of colorectal cancer (CRC) screening and low rates of knowledge regarding CRC screening tests and guidelines. Spanish speaking Latinos have particularly low CRC screening rates and screening knowledge. Our purpose was twofold: (1) to evaluate the effect of a computer-based, Spanish-language CRC screening decision aid on screening knowledge, intent to obtain screening, and screening self-efficacy in a community sample of Latinos with limited English proficiency (LEP); and (2) to survey these decision aid viewers at four months to determine their rates of CRC discussions with a health care provider as well as their rates of screening test completion.MethodsWe recruited 50-75 year old Latinos with LEP who were not current with CRC. Participants screening viewed a 14 minute multimedia decision aid that addresses CRC screening rationale, recommendations, and options. We conducted an uncontrolled (pre-post) study in which we assessed screening knowledge, self-efficacy, and intent at baseline and immediately after decision aid viewing. We also conducted a follow-up telephone survey of participants at four months to examine rates of patient-provider screening discussions and test completion.ResultsAmong n = 80 participants, knowledge scores increased from 20% (before) to 72% (after) decision aid viewing (absolute difference [95%CI]: 52% [46, 59]). The proportion with high screening self-efficacy increased from 67% to 92% (25% [13, 37]); the proportion with high screening intent increased from 63% to 95% (32% [21, 44]). We reached 68 (85%) of 80 participants eligible for the follow-up survey. Of these 36 (53%) reported discussing screening with a provider and 13 (19%) completed a test.ConclusionViewing a Spanish-language decision aid increased CRC screening knowledge, self-efficacy, and intent among Latinos with LEP. Decision aid viewing appeared to promote both CRC screening discussions with health care providers and test completion. The decision aid may be an effective tool for promoting CRC screening and reducing screening disparities in this population.

An Affective Booster Moderates the Relationship Between Message Frame and Behavioral Intentions

Abstract This study examined whether emotion moderates the degree to which framed messages influences colorectal cancer (CRC) screening intentions and self-efficacy for screening. Previous research has demonstrated that loss-framed messages are more effective than gain-framed messages in motivating detection behaviors such as screening. However, overall effects of framing in the context of health messages have been small and heterogeneous, highlighting the pressing need to identify moderators of framed message effectiveness. We paired a standard framing manipulation with an “affective booster” to increase anticipated and anticipatory emotions associated with the framed messages in a 2 × 2 (gain-loss by affective booster-no booster). The loss-framed message was paired with a complementary affective booster intended to facilitate worry and regret; the gain-framed message was paired with a complementary booster intended to facilitate relief. Consistent with previous research, we found that loss-framed messages were more effective in increasing intentions to screen for CRC (Î2 = -.38, t = -2.19, p = .03, d = 0.55). The inclusion of the affective booster had no overall effect on intentions to screen (Î2 = -.06, t = -0.39, p = .70, d = 0.10). However, we found a significant interaction (Î2 = .48, t = 2.13, p = .04, d = 0.53), such that among individuals who received gain-framed messages (but not loss-framed messages), the affective booster increased message persuasiveness. A similar pattern of results was uncovered with respect to self-efficacy for screening, where an affective booster increased self-efficacy among the gain-frame message recipients, bringing their self-efficacy in line with those who had received the loss-framed message. This study indicates that in the presence of affective boosters, loss-framed messages may lose their advantage over gain-framed messages in motivating detection behaviors.

Improving Internal Medicine Residents' Falls Assessment and Evaluation: An Interdisciplinary, Multistrategy Program

Falls are a major problem in older adults, and physicians receive inadequate training in falls evaluation. A multicomponent program (lecture, academic detailing, and case studies) was implemented to enhance medical residents' knowledge, skills, decisions, and interventions made about falls as part of a larger project to improve assessment and care of older adults. Electronic medical record (EMR) template modifications provided cues and reminders, decision support, and documentation into the visit note. Nursing staff and the EMR prompted residents to evaluate patients with a history of falls. Knowledge and confidence were assessed using a pre- and postintervention questionnaire, and an attending physician assessed skills by direct observation of the Timed Up and Go Test (TUG). Effect on clinical actions was assessed using the EMR database. Participation in training of faculty and staff was high. Over the 3-month intervention period, an attending physician reviewed the detailing sheet outlining important points of the training with 86% of residents, and 64% demonstrated a TUG to an attending physician. Of 895 older adults seen, 15% (134) had a positive screen for falls, of whom 92% (123) had an EMR falls template completed, and 42% (56) had a TUG performed. Of the patients evaluated with the TUG, 53% (29) failed. A review of charts for patients who failed the screen or TUG revealed that the majority had special circumstances limiting their participation, even after a physical therapy evaluation. Education and system changes facilitated improvements in resident knowledge, skill, self-efficacy, and clinical action in screening, evaluating, and managing falls in older adults.

A Randomized Controlled Trial of a Tailored Interactive Computer-Delivered Intervention to Promote Colorectal Cancer Screening: Sometimes More is Just the Same

There have been few studies of tailored interventions to promote colorectal cancer (CRC) screening. We conducted a randomized trial of a tailored, interactive intervention to increase CRC screening. Patients 50-70 years completed a baseline survey, were randomized to one of three groups, and attended a wellness exam after being exposed to a tailored intervention about CRC screening (tailored group), a public web site about CRC screening (web site group), or no intervention (survey-only group). The primary outcome was completion of any recommended CRC screening by 6 months. There was no statistically significant difference in screening by 6 months: 30%, 31%, and 28% of the survey-only, web site, and tailored groups were screened. Exposure to the tailored intervention was associated with increased knowledge and CRC screening self-efficacy at 2 weeks and 6 months. Family history, prior screening, stage of change, and physician recommendation moderated the intervention effects. A tailored intervention was not more effective at increasing screening than a public web site or only being surveyed.