Volume 24, Number 3, 2002
Tailoring Mammography Interventions
217
groups should be further investigated. The fact that African
American women in both the Indianapolis and St. Louis sam-
ples were not adherent at baseline may explain the difference in
findings of this versus previous studies. Skinner et al. (10) sug-
gested that the lack of difference by intervention group among
White women might have stemmed from the ceiling effect cre-
ated by initially high adherence rates at baseline. Clearly, it will
be important to continue to test such interventions among Afri-
can American and White women and begin to understand the
mechanisms by which various tailored interventions are and are
not effective within each group.
We also found that intervention effect varied by whether
women were living with or without a partner (Table 8). For
women with a partner, each intervention increased adherence,
although not significantly. The usual care group had an adher-
ence rate of 31% versus 39% to 42% for intervention group. For
women without partners, usual care group adherence rate was
lower (21%) at baseline, and intervention group adherence was
sults, however, it is evident that the combination of telephone
counseling and mailing was most effective across all groups.
Further recommendations must await continued follow-up and
cost-effective analysis.
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Several limitations indicate the need for caution when de-
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sample was limited to women who agreed to participate. This
of course creates the possibility that participants were more
motivated to comply than women who declined study partici-
pation. Just being in the study and responding to telephone
questions might have encouraged thoughts or behaviors that
would not have occurred without study participation. The re-
sponse rate for the Indianapolis sample was only 44%. How-
ever, given that participation required a 2-year commitment,
participation cannot be compared with one-time survey results.
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ported as accurate (38). Considering these limitations, the sig-
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mography use than did either tailored medium alone. Study
findings also support that interventions may be differentially
effective depending on sample characteristics, demonstrated in
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identify types of populations that most benefit from particular
interventions. As Skinner et al. (10) pointed out, it will be im-
portant to identify intervention methods that are most cost ef-
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