The impact of tailored interventions on a community health center population

We conducted a 4-year randomized study in a community health center that se rves primarily low income Blacks in Durham, North Carolina. Patients (1318 at baseline) were assigned randomly to one of three study groups: provider prompting intervention alone, provider prompting and tailored print materia ls or the previous group and tailored telephone counseling. The purpose of the study was to determine whether increasingly intensive, tailored print a nd telephone interventions also were increasingly effective in promoting ad herence to mammograms, Pap tests and overall cancer screening compliance. T hus, the combination of tailored print interventions (print and telephone) should have bean more effective than the provider prompting intervention al one, or the print intervention and prompting combination. This is one of th e few studies to examine a measure of overall cancer screening compliance a nd to assess the benefit of combinations of tailored interventions in promo ting adherence to cancer screening. Patients gave extremely high ratings to the interventions. At the bivariate level, we found a significant effect of the most intensive group (provider prompting intervention, tailored print communications and tailored telepho ne counseling) on Pap test compliance (P = 0.05) and borderline significanc e at the multivariate level (P = 0.06) as well on overall screening complia nce (P = 0.06). There was not a significant effect on mammography, probably because a majority of the patients were receiving regular mammograms. We a lso found some important subgroup differences. For example, a larger propor tion of women reported Pap tests in the tailored print and counseling group when they believed the materials were 'meant for me.' These results show t hat a combination of tailored interventions may have potential for reaching the women who have too often been labeled the 'hard to reach.' (C) 1999 El sevier Science Ireland Ltd. All rights reserved.