Cancer information service-initiated outcalls to promote screening mammography among low-income and minority women: design and feasibility testing.

BACKGROUND: The telephone information service of the Cancer Information Service (CIS) historically is most effective in eliciting calls from higher income, white women. This article describes the design and feasibility of a project that tested the use of telephone outcalls to extend the reach of the telephone information service to underserved women. METHODS: Neighborhoods throughout Colorado were identified using a geodemographic database (INFORUM) that allowed selection of census block groups according to demographic characteristics. Households were assigned randomly to: (1) a control group; (2) an outcall-only group, which received "cold" telephone outcalls promoting screening mammography; and (3) an advance card plus outcall group, which received a card introducing the program prior to the outcall. RESULTS: The use of INFORUM to target low-income, less educated, and black women was largely successful. While quality of intervention delivery was high, the protocol was labor intensive, requiring an average of 40 min to identify and counsel each eligible woman. The advance card did not increase acceptance of the outcalls. CONCLUSIONS: This approach successfully extended the CIS's audience; however, its labor intensity may limit its applicability. Strategies for increasing the efficiency of outcall efforts are suggested.

Effectiveness of a telephone outcall intervention to promote screening mammography among low-income women.

BACKGROUND: This study evaluated the impact of a telephone outcall intervention (based on the Transtheoretical Model) on screening mammography behavior among lower income, older women. METHODS: A geodemographic database, INFORUM, was used to identify low-income and minority neighborhoods throughout the state of Colorado. Residences were assigned randomly to three study groups: (1) control, (2) outcall only, and (3) advance "invitation" + outcall. Information Specialists of the Cancer Information Service implemented the protocol. Mammography adherence was assessed in telephone interviews conducted 6 months and 2 years after the initial call. RESULTS: Neither intervention had a significant effect on the main outcome, receipt of mammography in the 6-month follow-up period. At 6 months, intentions to have a mammogram were significantly stronger in the intervention groups compared with the control group, particularly among those who were precontemplators at baseline. The 2-year follow-up indicated a small increase in mammography adherence attributable to the advance invitation + outcall, but this effect was restricted to those adherent at baseline. Mammography behavior during the 6-month follow-up period was predicted strongly by decisional balance, intentions, receipt of a physical and clinical breast exam, and previous mammography behavior. CONCLUSIONS: The intervention promoted minimal movement in the stages of change for mammography. Outcall interventions may have promise for encouraging repeat mammography behavior, but more intensive interventions are likely to be necessary to promote behavior change among nonadherent women.

Information-management technology in the Cancer Information Service.

This paper identifies the potential applications of information-management technology in the Cancer Information Service national network and describes some innovations of individual network offices in each area. New applications are explored and recommendations are made for coordinating these efforts nationally.

The Cancer Information Service as a laboratory for research: the first 15 years.

Over the past 15 years, the Cancer Information Service (CIS) of the National Cancer Institute has generated a substantial body of research. In the present report, this research is reviewed as it pertains to five key questions: 1) Who uses the CIS? 2) What are the topics of inquiry? 3) How do callers learn of the CIS? 4) Do CIS campaigns and unplanned events affect CIS call volume? 5) Can the CIS influence behavior? Major conclusions from this review can be summarized as follows: 1) The vast majority of callers to the CIS are female, White/Anglo, and of middle-class background. 2) Most calls relate directly or indirectly to cancer-treatment issues. 3) A variety of media and sources are reported by CIS callers, with television ranking high across most studies. 4) CIS call volume can be substantially influenced by promotion campaigns and unplanned events. 5) The available evidence suggests that the CIS can influence behavior, especially information-seeking behavior. Recommendations for future research are discussed in light of the results of this review.