Increasing fruit and vegetable consumption among callers to the CIS: results from a randomized trial.

BACKGROUND: Results are reported from a large randomized trial designed to increase fruit and vegetable consumption among callers to the Cancer Information Service (CIS). METHODS: CIS callers assigned to the intervention group received a brief proactive educational intervention over the telephone at the end of usual service, with two follow-up mailouts. Key educational messages and print material derived from the NCI 5 A Day for Better Health program were provided to intervention subjects. Subjects were interviewed by telephone at both 4-week (n = 1,672) and 4-month (n = 1,286) follow-up. RESULTS: A single-item measure of fruit and vegetable consumption revealed a significant intervention effect of approximately 0.65 servings per day at 4-week follow-up (P < 0.001) and 0.41 servings per day at 4-month follow-up (P < 0.001). Using a seven-item food frequency measure that was also included in the 4-month interviews, a similar intervention effect of 0.34 servings per day was obtained (P = 0.006). The vast majority of CIS callers (88%) endorsed the strategy of providing 5 A Day information proactively. CONCLUSIONS: A brief educational intervention delivered to CIS callers at the end of usual service was associated with an increase in self-reported fruit and vegetable intake.

Information technologies within the cancer information service: factors related to innovation adoption.

CONCLUSIONS: This collaborative study, conducted by members of the Cancer Information Service Research Consortium Team for Evaluation and Audit Methods and the Network Analysis Advisory Board, is part of a larger project that evaluates the impact of communication structure on innovation within the contractual network of the Cancer Information Service (CIS). This study examines four different technological innovations with respect to the characteristics of relative advantage, compatibility, observability, complexity, trialability, adaptability, riskiness, disadvantage, computer knowledge, and acceptance. METHODS: Data were gathered from self-report questionnaires completed in May 1995 by organizational members (n = 82) within the National Cancer Institute's CIS, a geographically dispersed federal government health information program. RESULTS: Paired comparison t tests found that organizational members rate contrasting dimensions of an innovation differentially, depending on the nature of the specific technology. For example, significantly lower levels of riskiness were reported for computerization for communication (e.g., e-mail) than for computerization for telephone service or outreach. In addition, computerization for office management had significantly lower levels of riskiness than computerization for telephone service or outreach. With respect to complexity, computerization for communication had significantly lower ratings than did outreach. In terms of observability and trialability, computerization for communication had significantly lower ratings than for telephone service. With respect to relative advantage, computerization for office management had significantly lower ratings than all other areas of computerization. In terms of computer knowledge, ratings were significantly higher for communication than for all other areas of computerization. No significant differences were found between contrasting innovations for adaptability or acceptance. CONCLUSIONS: Results suggest that organizational members rate contrasting dimensions of an innovation differentially, depending on the nature of the specific innovation. Managers can employ this information as a diagnostic tool to evaluate the fit of an innovation, anticipate problems arising as a result of innovation, and modify innovations to reflect the changes that stakeholders deem necessary. Computerization efforts such as this one are at the cutting edge of efforts to improve the dissemination of information to the public. These efforts can result in considerable improvements in public health.

Balancing research and service: the experience of the cancer information service.

BACKGROUND: The National Cancer Institute's Cancer Information Service (CIS), the nation's foremost resource for cancer information, has supported cancer control research throughout its 22-year history. The Cancer Information Service Research Consortium (CISRC) is a consortium established to fully involve the CIS in theory-based cancer control research. METHODS: This paper focuses on the experiences of the CIS Project Directors in the development and implementation of three research projects within the CIS program. Conclusions are drawn from discussions that have taken place over time in such venues as conference calls, CISRC Members Council meetings, and project advisory meetings. RESULTS: Overall, the CISRC/CIS collaboration has been successful. A number of factors have contributed to this success, including the perceived value of the research within the CIS and the mechanisms and structures established to foster collaboration. The lessons learned, based on the challenges and opportunities of implementing these intervention research projects within the operations of the regional CIS offices, are discussed. CONCLUSIONS: Integration of research within a service program requires careful planning and preparation. Mutual benefit, shared ownership, consistency with current practice, staff training, and the value of research to each partner were essential ingredients to the success of this collaboration.

Promoting screening mammography in inner-city settings: a randomized controlled trial of computerized reminders as a component of a program to facilitate mammography.

In a one-year randomized controlled trial, we assessed the effectiveness of a computerized mammography reminder system as a component of a program to increase the use of screening mammography in three health care organizations serving inner-city women in Detroit, Michigan (two sites of a health department, one HMO site, and two sites of a private hospital). Four thousand four hundred and one women older than 40 who had visited a study site in the preceding year were randomly assigned to one of two treatment groups. Limited intervention (LI) included physician and staff breast cancer control education, facilitated mammography appointment scheduling procedures, and elimination of out-of-pocket patient cost for mammography (at three of five sites). Full intervention (FI) included all components of limited intervention plus an additional series of "cues-to-action." These included a mammography reminder form inserted in the medical record of women who were due to have mammography, intended to increase physician referral for mammography appointments, and patient reminders intended to increase completion of mammography among referred women. During the one-year intervention period 2,725 randomized women visited a study site. The 6-month mammography appointment rates among FI women vary from 38% to 65% and the FI rate exceeds the LI rate at each site with differences from 13% (95% CI, 6 to 20) to 29% (21 to 38). The annual completed mammography rate among FI women extends from 43% to 64% and exceeds the LI rate at each site by 12% (5 to 19) to 25% (16 to 34). After age-adjustment, the mammography intervention effect sizes among the five sites were not significantly different. The average increase in FI compared to LI was 18%. The computerized reminder system is effective in increasing the use of mammography in each of the study institutions and the major effect is on physician referral for mammography.

Patterns of use of mammography among inner-city Detroit women: contrasts between a health department, HMO, and private hospital.

This study assessed the pattern of utilization of mammography among 2,880 inner-city minority women 40 years of age or older who received ongoing primary care services during 1988 or 1989 at four practice sites operated by a health department (two sites), Health Maintenance Organization (HMO), and private hospital. Mammography referral could be documented for 23% to 32% of age eligible women and completed mammograms for 15% to 26%. Among women without a mammogram, 85% had never been referred while 15% were referred but unable to complete the procedure. In multiple logistic regression analysis, factors associated with mammography include age less than 70 years, presence of a breast cancer risk factor and more frequent clinic visits. Mammography was somewhat more frequent at the HMO and hospital clinic than at the health department, but this relationship varied with the women's previous visit and mammography experience. At sites serving uninsured women, mammography use was not associated with the presence or absence of health insurance. It is concluded that the underutilization of mammography is a substantial barrier to the early detection of breast cancer in each of the three different health care organizations studied, and that interventions to improve breast cancer control should focus upon facilitating physician referral practices.

Outreach programs and their effects within the Cancer Information Service network.

Outreach programs have been part of the Cancer Information Service (CIS) program since its outset. The scope of work of the first two CIS contracts gave broad responsibilities to the local offices for public and professional education, responsibilities that were carried out in a diverse fashion with little national direction. As the National Cancer Institute (NCI) Office of Cancer Communications matured and became more directed, the CIS local offices began successfully to implement programs with the Office of Cancer Communications and through intermediary groups. The Partners in Prevention (PIP) effort, launched by NCI in 1984, was the first major national community education program in which all the CIS offices participated. Shortly after the inception of PIP, however, the outreach personnel were deleted from the CIS contracts, due to budget restrictions. When the outreach component was reinstituted in 1990, the structure of the program changed to a catalytic role, working with local media and intermediary organizations to bring the NCI program messages and materials to targeted audiences and memberships. Under the reconfigured CIS network, the outreach program will serve as a resource to both those community institutions that are funded by NCI and those that are not and will be proactive in intermediary development. This paper details the chronology of the program and presents some of the research issues that need to be addressed in the future.

Detroit's avoidable mortality project: breast cancer control for inner-city women.

Mammography remains substantially under-used in low-income minority populations despite its well-established efficacy as a means of breast cancer control. The Metropolitan Detroit Avoidable Mortality Project is a 2-year controlled clinical trial of coordinated interventions which seek to improve the use of early breast cancer detection services at five clinical sites providing primary health care services to inner-city women. Baseline assessment for two of the five participating clinic populations demonstrated that only one-quarter of women who visited these clinics were referred for mammography in 1988, and only half of those who were referred were able to complete the procedure. Patient characteristics including age, marital status, ethnicity, and insurance status were not associated with use of mammography during the baseline period. Each of the project's intervention components is a cue to action: a physician prompt for mammography referral within the medical record of procedure-due women, a reminder postcard for scheduled appointments, and a telephone call to encourage rescheduling of missed appointments. The interventions are initiated by a computerized information management system in the existing network of health care services. The patient's out-of-pocket mammography expense has been eliminated in three of the five sites. Although their efficacy as individual interventions has been well established, a controlled trial of computer prompts to physicians, reduced expense for patients, and patient appointment reminders as an integrated system in inner-city medical care settings has not been previously described. We have implemented the prompting, facilitated rescheduling procedures, and eliminated patient expense for mammography at three of five eventual clinical sites. This report provides an overview of the study's design, data management system, and methodology for evaluation.