Intervention Mediators in a Randomized Controlled Trial to Increase Colonoscopy Uptake Among Individuals at Increased Ri
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ORIGINAL ARTICLE
Intervention Mediators in a Randomized Controlled Trial to Increase Colonoscopy Uptake Among Individuals at Increased Risk of Familial Colorectal Cancer Barbara H. Brumbach, PhD 1 & Wendy C. Birmingham, PhD 2 & Watcharaporn Boonyasiriwat, PhD 3 & Scott Walters, PhD 4 & Anita Y. Kinney, PhD, RN 5
# The Society of Behavioral Medicine 2017
Abstract Background Understanding the pathways by which interventions achieve behavioral change is important for optimizing intervention strategies. Purpose 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. Conclusion 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. Tr i a l R e g i s t r a t i o n N u m b e r C l i n i c a l Tr i a l s . g o v, NCT01274143.
Electronic supplementary material The online version of this article (doi:10.1007/s12160-017-9893-1) contains supplementary material, which is available to authorized users.
Keywords Colorectal cancer screening . Colonoscopy . Extended parallel process model . Implementation-intention strategies . Structural equation modeling
* Barbara H. Brumbach [email protected]
1
Department of Individual, Family, & Community Education, University of New Mexico, Albuquerque, NM, USA
2
Department of Psychology, Brigham Young University, Provo, UT, USA
3
Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand
4
Department of School of Public Health Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, TX, USA
5
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
Introduction In the USA, colorectal cancer is a leading cause of cancer-related death in both men and women [1]. Average lifetime risk for developing colorectal cancer is approximately 5% in the general population; risk increases twofold to fourfold or more if an i
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