• Journal of Preventive Medicine and Public Health
• /
• v.44 no.3
• /
• pp.101-110
• /
• 2011

Objectives: Screening for colorectal cancer is considered cost effective, but is underutilized in the U.S. Information on the efficiency of "tailored interventions" to promote colorectal cancer screening in primary care settings is limited. The paper reports the results of a cost effectiveness analysis that compared a survey-only control group to a Centers for Disease Control (CDC) web-based intervention (screen for life) and to a tailored interactive computer-based intervention. Methods: A randomized controlled trial of people 50 and over, was conducted to test the interventions. The sample was 1224 partcipants 50-70 years of age, recruited from Kelsey-Seybold Clinic, a large multi-specialty clinic in Houston, Texas. Screening status was obtained by medical chart review after a 12-month follow-up period. An "intention to treat" analysis and micro costing from the patient and provider perspectives were used to estimate the costs and effects. Analysis of statistical uncertainty was conducted using nonparametric bootstrapping. Results: The estimated cost of implementing the web-based intervention was $40 per person and the cost of the tailored intervention was $45 per person. The additional cost per person screened for the web-based intervention compared to no intervention was $2602 and the tailored intervention was no more effective than the web-based strategy. Conclusions: The tailored intervention was less cost-effective than the web-based intervention for colorectal cancer screening promotion. The web-based intervention was less cost-effective than previous studies of in-reach colorectal cancer screening promotion. Researchers need to continue developing and evaluating the effectiveness and costeffectiveness of interventions to increase colorectal cancer screening.

• Korean Journal of Health Education and Promotion
• /
• v.23 no.2
• /
• pp.77-89
• /
• 2006

Objectives: Recent studies have shown that tailoring to women's individual beliefs and stage of cancer screening adoption increase the probability that cancer screening will ensue. To identify variables associated with cancer screening behavior, many studies for cancer screening have used the Transtheoretical Model(TTM). This study was carried out to identity the cognitive and behavioral factors associated with breast cancer screening by stages of change among women, forties aged. Methods: Building on the TTM constructs, we collected the data to test the association with cognitive and behavioral factors for breast cancer screening by stage of change among women, forties aged (N=232), using the self-reported questionnaire. The stages of change were grouped according to screening participation and intention for breast cancer as precontemplation, contemplation, preparation, action, and maintenance. We found out the association between breast cancer screening and cognitive and behavioral factors, and testified the difference between stages of change by chi-square test, one-way ANOVA, and multiple comparison analysis(Duncan test). Results: Analyses of 232 women showed that participation on mammography was 68.1% within lifetime and 46.1% within last 2 years, and we found out the association with breast cancer screening participation, intention and cognitive-behavioral factors. The stages of change based on participation and intention were different from the decisional balance, the screening attitude, and the self-efficacy(p<0.01). The decisional balance was differ from stages of change because the difference on opinions about pros(positives) and cons(negative) were likely to significant by stages of change(p<0.05, p<0.01). Conclusion: To increase the screening rate for breast cancer, it should be developed the tailored message and recommend guideline. And the tailored message should be designed to increase the pros of breast cancer screening(mammography) and to decrease the cons, and considered the woman's stage of adoption.

• Korean Journal of Health Education and Promotion
• /
• v.22 no.2
• /
• pp.97-110
• /
• 2005

Objectives: Recent studies have shown that tailored messages for cancer screening to the beliefs and stage of cancer screening behavior of individual women increases the take-up probability. Many studies on cancer screening have used the Transtheoretical Model (TTM) to identify variables associated with cancer screening behavior. This study was carried out to identify the cognitive-behavioral factors associated with stomach cancer screening among women aged 40 years and over, and to develop and evaluate a tailored educational program for stomach cancer screening by stages of change. Methods: Building on the TTM constructs, we conducted a quasi-experimental study(N=283) to test the effectiveness of a tailored educational program for endoscopic stomach cancer screening. We carried out pre and post tests in the experimental group(N=162) and the control group(N=121), and the experimental group was subdivided into an on-line group(N=81) and an off-line group(N=81) by educational methodology using e-mail and the postal service. We used the chi-square test, trend test, and paired t-test to test the effectiveness of the program for stomach cancer using a tailored stage-matched messages. Results: To examine the effectiveness of the program for stomach cancer screening by the tailored stage-matched messages, the stage-matched materials were offered to the experimental group(N=162) four times for 4 weeks. The stage-matched materials consisted of the four types for stomach cancer. The tailored message was effective in changing the cognitive-behavioral factors, such as experience process, behavior process, con opinion for stomach cancer, self-efficacy, and the behavioral stages for stomach cancer screening. The stomach cancer screening adherence was higher for the stage-matched materials using postal mail than for those using e-mail. Conclusion: To improve the stomach cancer screening rate, the use of tailored messages for stomach cancer screening will be generated using an expert system. Therefore the implementation of tailored educational program will be supported a partnership between public and private health organizations and increasing awareness of the necessity of community-based interventions.

• Journal of Korea Association of Health Promotion
• /
• v.3 no.2
• /
• pp.280-287
• /
• 2005

The Government bean implementing the National Cancer Screening Program(NCSP) in 1999 and expanded its target population and target cancers. The target cancers of NCSP since 2004 are the five most common cancers in Korea: stomachm liver colorectal, breast, cervical cancer. One goal of the NCSP in 2005 is to include in its target population up to lower 50% of premiu of National Health Insurance. The Government and National Cancer Center have bee developing the protocol for the NCSP with associated related academic societies Health Centers operate the NCSP with National Health Insurance Cooperation. The Particioants of NCSP in 2004 are 1.34million, 14% of target population and the detection rate 2004 is 0.07%. NCSP has three challenges. Firstly, NCSP improves the participant rate through educating cancer screening increasing the access of screening(e.g. mobile screening unit), and increasing reimbursement fee Secondly NCSP assesses the quality of screening with related academic societies and implement the intervention for quality improvement. Thirdly, NCSP continues to increase the cost-effectiveness through modification of target population, screening interval, method, and information system.

• Korean Journal of Health Education and Promotion
• /
• v.27 no.2
• /
• pp.79-93
• /
• 2010

Objectives: This study aims to identify the factors associated with the stages of change in colorectal cancer screening, and develop a model explaining these stages of change by using structural equation modeling analysis. Methods: On the basis of literature review and expert advice, we constructed our hypothetical model that consisted of five theoretical constructs(process of change, pros, cons, self-efficacy, stage of change). In 2009, data was collected from 486 participants aged between 50 and 69. The data were analyzed by SPSS 15.0 and AMOS 6.0. Results: In the case of stage of adoption, the contemplation stage was the most common (37.4%), followed by the action stage (26.5%). In the final model of the stage of change for colorectal cancer screening, there was a direct influence of the process of change ($\gamma$=.562, p<.001), and cons ($\gamma$=.132, p<.01) on the stage of change with the terms of GFI .931, AGFI .904, RMR .038, NFI .930, and NNFI .936. Conclusion: It is necessary to produce and disseminate evidence-based cancer screening information, which can mitigate the negative attitude among the public toward cancer screening. Also, it is essential to provide a safer and more comfortable environment at cancer screening center.

• Journal of Preventive Medicine and Public Health
• /
• v.34 no.3
• /
• pp.237-243
• /
• 2001

Objectives : To examine the screening rate of cervical cancer in women and to find out the predictive factors for participation in cervical cancer screening programs within their life-time and within the last two years. Methods : The data was based on self-reported questionnaires from 1,613 women whose ages ranged from 26 to 60 years; this survey was peformed between December 1999 and January 2000. This study analyzed the predictive factors for participation in cervical cancer screening programs within their life-time and within the last two years. A logistic regression analysis was performed in order to derive the significant variables from the predisposing factors(demographic factor, health promotion behavior, reproductive factor), intervention factors(information channel, relation with medical stan, and proximal factors(attitude, social influence, self-efficacy). All analyses were peformed by the PC-SAS 6.12. Results : Our analyses showed that the screening rate for the women who received a cervical cancer screening(Pap smear) more than once within their life-time was 56.1% while those who had received one within the last two years was 34.5%. The significant factors for participation in cervical cancer screening program within their life-time were their income, married age, health promotion score, relation with medical staffs, social influence, and self-efficacy. On the other hand, age, number of pregnancies, menarche age, relation with medical staffs, social influences, and self-efficacy were significant factors for those being screened within the last two years. The predictive power of the logit model within their life-time was 68.8% and that within the last two years was 66.6%. Conclusion : The predictive factors for participation in cervical cancer screening program within their life-time are different from those for within the last two years. and that women's relations with medical staffs and social influences were the critical factors impacting on cervical cancer screening rates.

• Journal of Korea Association of Health Promotion
• /
• v.2 no.1
• /
• pp.85-91
• /
• 2004

• Asian Pacific Journal of Cancer Prevention
• /
• v.17 no.8
• /
• pp.3939-3943
• /
• 2016

Background: According to recent statistics, the breast cancer rate is growing fast in developing countries. In North West of Iran, the incidence of breast cancer after esophageal and gastric cancers has the highest rate. Previous studies have also indicated that women in this region show reluctance to do breast cancer screening. There is a great need for change to promote breast cancer screening among women. Social marketing is a discipline that uses the systematic application of commercial marketing techniques to promote the adoption of behavior by the target audience. Materials and Methods: In the present qualitative study, thirty-two women with breast cancer were interviewed about their experiences of breast cancer screening. A semi-structured interview guide was designed to elicit information specific to the 4 P's in social marketing. Results: Three main categories emerged from the analysis: price, service and promotion. Subcategories related to these main categories included factors effective in increasing and decreasing cost of screening, current and desirable features of screening services, and weakness of promotion. Conclusions: Screening programs should be designed to be of low cost, to meet patients' needs and should be provided in suitable places. Furthermore, it is essential that the cultural beliefs of society be improved through education. It seems necessary to design an executive protocol for breast cancer screening at different levels of primary health care to increase the women's willingness to undergo screening.

• Asian Pacific Journal of Cancer Prevention
• /
• v.17 no.7
• /
• pp.3505-3510
• /
• 2016

Cervical cancer is a major public health problem in Thailand, being ranked second only to breast cancer. Thai women have been reported to have a low rate of cervical cancer screening (27.7% of the 80% goal of WHO). We therefore aimed to apply the social marketing theory and health belief model in promoting cervical cancer screening in Kanthararom District, Sisaket Province. A total of 92 from 974 targeted women aged 30-60 years were randomly divided into two groups. The experimental group underwent application of social marketing theory and a health belief model program promoting cervical cancer screening while the control group received normal services. Two research tools were used: (1) application of social marketing theory and health belief model program and (2) questionnaire used to evaluate perceptions of cervical cancer. Descriptive and inferential statistics including paired sample t-test and independent t-test were used to analyze the data. After the program had been used, the mean score of perception of cervical cancer of experimental group was at a higher level (${\bar{x}}=4.09$; S.D.=0.30), than in the control group (${\bar{x}}=3.82$; S.D.=0.20) with statistical significance (p<0.001). This research demonstrated an appropriate communication process in behavioral modification to prevent cervical cancer. It can be recommended that this program featuring social marketing and the health belief model be used to promote cervical cancer screening in targeted women and it can be promoted as a guideline for other health services, especially in health promotion and disease prevention.

• Journal of Korean Public Health Nursing
• /
• v.20 no.1
• /
• pp.28-38
• /
• 2006

Purpose: To explore the level of health status and health promotion lifestyle, and the group differences in health promotion lifestyle among Seoul citizens who participated in free hypertension screening. Methods: This study was a cross sectional descriptive design. The administered questionnaire included the Health-Promoting Lifestyle Profile II (HPLP II), perceived health status scale, and demographic questions. Blood pressure was measured by researcher teams. Data were collected from July 2 to 6, 2004 in the waiting area of subway stations 7 in Seoul. The study subjects were 168 adults. Results: The average age of the respondents was 55.45 years and 38.7% of them perceived themselves as healthy, while 44% did not know their own blood pressure. Among the participants, 44.6% were classified as 'prehypertensive', and 36.9% as having high blood pressure. The mean score of health promotion lifestyle was 2.62 and the order of subcategories of health promotion lifestyle was interpersonal relationship, spiritual growth, nutrition, stress management, physical activities, and health responsibilities. The subcategories of health promotion lifestyle differed significantly by age, sex, job, and smoking. Conclusions: It is important to encourage adults to participate actively in health promotion. In addition, health promotion programs should be developed and implemented based on group differences.