***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In 1987 , the Division of Cancer Prevention and Control , National Cancer Institute ( NCI ) , funded a r and omized trial of a proactive counseling protocol to promote screening mammography among age-eligible female callers to the Cancer Information Service ( CIS ) . This protocol included interactive counseling by CIS counselors to help callers overcome barriers to screening mammography ;  this counseling was an extension of usual service and was combined with a 2-week follow-up mailout to reinforce the brief ( 6-minute ) proactive telephone-counseling protocol . The screening-mammography counseling intervention was tested in two regional CIS offices using a r and omized two-group design . Callers were r and omly assigned to the intervention or control group based on the week of their call to the CIS ( n = 1831 eligible female callers ) .  Self-reported adherence to NCI screening-mammography guidelines was assessed from telephone interviews conducted at 12 months ' follow-up ( 87 % response rate ) . Among all CIS callers enrolled in this study , self-reported adherence to screening-mammography guidelines at 12 months ' follow-up was 63.5 % . The most frequently cited barriers to screening mammography reported by CIS callers were inconvenience/being too busy ( 52 % ) , cost ( 36 % ) , lack of physician referral ( 34 % ) , no symptoms ( 34 % ) , and fear of radiation ( 29 % ) . A significant intervention effect on adherence behavior was found but only in one of the two test sites and only among CIS callers reporting total family income of $ 30,000 or more ( odds ratio = 1.38 , P = .04 ) . The vast majority ( 90 % ) of CIS callers ( both intervention and control subjects ) endorsed the concept of  proactive counseling  by the CIS . The implication s of these findings for the CIS and future research are discussed Background : Interventions to improve adherence to regular mammography screening  have had conflicting results . Many studies have depended on women ’s self-report rather than clinical evidence of a mammography encounter . Methods : We tested the impact of two interventions on a population -based sample of NH women who were not receiving routine mammography to determine if adherence to screening could be improved . The interventions included a mailing of women ’s health information and a telephone counseling intervention based on the Transtheoretical Model . Participant eligibility and outcome measures were based on clinical events obtained from a population -based mammography registry . Results : Two hundred and fifty eight women completed all aspects of the intervention study . The women were r and omly assigned to one of two study groups : 51 % received the mail intervention and 49 % received the telephone intervention . Among women who received the telephone counseling intervention , 67 % percent reported being in either an action or maintenance stage at Call 1 , which increased to 84 % at Call 2 ( p<0.001 ) . Seventy-six percent of women identified barriers to screening mammography at Call 1 , which decreased to 44 % at Call 2 ( p<0.01 ) . The most frequently identified barrier was confusion over the guidelines for screening mammography . At the first assessment time interval , greater than 60 % of women were up-to- date for screening mammography in the group that received telephone counseling versus 48 % in the group that received health information by mail ( p = 0.04 ) . However , women ’s status as up-to- date fell for both groups between the first and second assessment time intervals . Conclusions : Tailored telephone counseling based on the Transtheoretical Model can improve adherence to screening mammography , though the duration of this effect is in question Two theory-based programs to increase mammography screening rates among asymptomatic women were implemented and evaluated in the community . One program ( E ) was based on the Health Belief Model ( HBM ) ; the second program ( EP ) added exercises adapted from the social psychology of compliance . Program impact on screening among 295 primarily Caucasian , middle-class women was evaluated against untreated controls ( C ) over a 6-month period . Both programs led to increases in HBM components ( Perceived Susceptibility , and Perceived Benefits ) and Intentions to obtain a mammogram . Screening rates 2 to 3 times higher were observed in the EP and E over C conditions ; EP and E did not differ . A mediational model of compliance illustrated the interplay of HBM components in the compliance process Abstract BACKGROUND : R and omized controlled trials have demonstrated that fecal occult blood testing ( FOBT ) reduces colorectal cancer ( CRC ) mortality . However , patient compliance with FOBT is low and this is one of the major barriers to CRC screening . OBJECTIVE : To determine whether intensive patient education increases FOBT card return rates . DESIGN : R and omized controlled trial . SETTING : Department of Veterans Affairs primary care clinic . PARTICIPANTS : Seven hundred eighty-eight patients who were referred for FOBT . INTERVENTIONS : Patients were r and omly allocated to receive either intensive ( n=396 ) or st and ard ( n=392 ) patient education . Patients in the intensive education group received a one-on-one educational session by primary care nurses on the importance of CRC screening , were instructed on how to properly collect stool specimens for FOBT , and were given a 2-page h and out on CRC screening . Patients in the st and ard education group only received the FOBT cards and written instructions from the manufacturer on how to properly collect stool specimens for FOBT . RESULTS : Patients in the intensive education group were more likely to return the FOBT cards ( 65.9 % vs 51.3 % ; P<.001 ) and called the clinic with additional questions less often ( 1.5 % vs 5.9 % ; P=.001 ) than the st and ard education group . The median time to return the FOBT cards was significantly shorter in the intensive education group ( 36 vs 143 days ; P<.001 by log-rank test ) . However , the proportion of patients who had a positive FOBT did not differ in the two groups ( 4.6 % vs 6.0 % ; P=.51 ) . CONCLUSIONS : Intensive patient education significantly improved patient compliance with FOBT . Future studies to evaluate additional educational strategies to further improve patient compliance with CRC screening are warranted BACKGROUND The five-year survival rate for African American women with breast cancer is notably lower than the rate for white women ; thus , appropriate cancer education and screening efforts are needed to increase mammography and breast self-examination practice s by African American women . METHODS The Witness Project is a theory-based intervention design ed to provide culturally sensitive messages , from African American breast cancer survivors , in churches and community organizations . These messages emphasize the importance of early detection to improve survival . RESULTS Intervention research in eastern Arkansas with 204 African American women demonstrated a significant increase in the practice of breast self-examination  ( p < 0.001 ) and  mammography  ( p < 0.001 ) after participation in the Witness Project . There was no significant difference between the pre- and postintervention scores for scaled items for the health-belief model and locus of control . CONCLUSIONS Results demonstrate that culturally appropriate cancer education programs are able to change behavior by meeting the beliefs of participants rather than attempting to change their beliefs The Singapore Breast Screening Project was a nationwide study inviting a r and om sample of women between the ages of 50 and 64 years for mammography at one of two hospital-based screening centres over two years . The current study was undertaken to determine if ( 1 ) mailed health educational material alone , or ( 2 ) the same material delivered during a home visit made to the subject and her family would increase the uptake among Singapore women who had not responded to two previous invitations for mammographic screening as part of the Project . This r and omized trial employed a st and ard second reminder letter ( R ) , the same letter packaged with health education material design ed for the project ( RP ) and the addition of a home visit to make contact with the woman and her family ( RV ) . The outcome measure of interest was the proportion of women in each group subsequently attending for screening .  The study population comprised 1500 non-attenders whose names appeared consecutively in the data base of the larger screening centre in this Project . These were r and omized into three groups of 500 each . In total , they broadly resembled the national population in ethnic composition ( 72.3 % Chinese , 17.8 % Malays , 9.0 % Indians and 0.8 % Others ) . By the end of the project , 7.0 % of women in group R and 7.6 % in group RP responded to the invitation . In group RV , 428 homes were visited at least once and contact was made with the subject and her family member in 306 ( 71.5 % ) cases . Subsequently , 13.3 % of the women visited attended for screening . The rate ratio for attendance in group RP compared with group R was 1.09 ( 95 % CI 0.70 to 1.70 ) and for group RV compared with R , 1.90 ( 1.27 to 2.84 ) . When analyzed by groups originally assigned to , women in group RV remained significantly more likely to attend than those in groups R or RP . The marginal cost of a home visit , based on this study , was $ 25.04 per additional woman screened . Our results suggest that the response to a second reminder is generally low and that additional print material does not improve screening attendance in this group of initial non-attenders . Personal contact with the family through a home visit appears to increase uptake , and may be helpful particularly among women who have less frequent contact with the health care system OBJECTIVES This study assessed whether the Learn , Share & Live breast cancer education program result ed in favorable , replicable , and sustainable outcomes . METHODS The program was implemented at index ( year 1 ) and replication ( year 2 ) sites . Baseline interviews ( year 1 ; n = 240 ) and 2 follow-up telephone interviews ( years 2 and 3 ; n = 337 and 323 ) were used to assess postintervention changes . RESULTS From baseline to year 2 , mammography adherence and stage of adoption improved at the index site relative to the replication site . Knowledge scores and percentages of respondents reporting that a friend had spoken with them about mammography improved significantly . Improvements were sustained through year 3 ( 2 years postintervention ) . In year 3 , replication participants showed improvements in regard to knowledge and perceived mammography benefits , and there was a trend toward increased adherence . Site differences in postintervention adherence may have stemmed from respective choices of follow-up activities . CONCLUSIONS The study outcomes affirm the impact of Learn , Share & Live , indicating a replicated and sustained program effect . Future studies should continue longer follow-up and explore the importance of providing mammography opportunities along with education The recent decrease in breast cancer mortality has been linked in part to increased breast cancer screening . Although the percentage of women screened once is rising , rate of continued adherence is poor . The purpose of this article is to assess the effects of tailored mammography interventions implemented prospect ively in a factorial design contrasting groups receiving either ( a ) usual care ( no intervention ) , ( b ) tailored telephone counseling for mammography , ( c ) tailored mailed material s promoting mammography , or ( d ) a combination of tailored mail and telephone counseling . This prospect i ve , r and omized study with a 2 x 2 factorial design included women 51 years and older ( N = 1,367 ) who were not adherent with mammography at baseline . The intervention is based on integration of the Transtheoretical and Health Belief Models . Participants were enrolled in one of two health maintenance organizations or seen in a university-related primary care clinic . Baseline data were collected on mammography history and beliefs and knowledge related to mammography . Data were collected via telephone interviews using previously developed scales . The follow-up interviewers were conducted with 976 women . The sample was 41 % White , 56 % African American , and 3 % other . Mean age at baseline was 66.5 . Logistic regression indicates that postintervention mammography status in all three intervention groups was significantly better than usual care , with odds ratios ranging from 1.66 ( telephone only ) to 2.16 ( telephone plus mail ) The effect on women ’s breast cancer screening utilization of a barrier-specific telephone counseling ( BSTC ) intervention , with and without a concurrent continuing medical education ( CME ) activity for their physicians , was evaluated . All participants ( 50 - 80 years of age ) were not regular mammography users at baseline . A 4-arm quasi-experimental design was employed . Women were r and omized to the BSTC or no BSTC group and assigned ( with their physicians ) to the CME or no CME group based on place of residence . Pre- and postintervention data were obtained for 1,601 women using telephone interviews conducted during 1995 and 1998 , respectively . Among women who had ever used mammography at baseline , those who received BSTC were more likely than the control group to become regular mammography users at follow-up ( OR = 1.4 , p = .033 ) . Greater reductions in perceived barriers to mammography , from baseline to follow-up , were significantly associated with receiving BSTC compared with the control group ( p = .001 ) , among women with previous mammography experience . Findings suggest that CME may have potential for initiating mammography use among women who never had a previous mammogram . However , because of the small sample available for analyses of the CME intervention and differential attrition among women who never had a previous mammogram , further study is needed to confirm this hypothesis This study evaluated the effects of interactive voice response ( IVR ) system rem 
    Output:
    
Forty-five studies were included in the review s. EVIDENCE SYNTHESIS Recommendations were added for one-on-one education to increase screening with fecal occult blood testing ( FOBT ) and group education to increase mammography screening .
Evidence remains insufficient to determine effectiveness for the remaining screening tests and intervention categories .
Findings indicate new and reaffirmed interventions effective in promoting recommended cancer screening , including colorectal cancer screening .