Table 3.

Nature of intervention (n = 11 intervention studies)

Intervention strategies targeted to the individual level
Intervention strategies included in-person education (n = 4), telephone calls (n = 4), mailings (n = 5).a The majority of interventions (n = 7) were delivered or managed by one person, a nurse, or study staff member. Some involved multiple staff, such as a practice manager working with primary care physicians. A few used multiple strategies by nurses, navigators, a lay navigator, social worker, and physician.One study investigated the performance of follow-up (colposcopy and subsequent medical recommendations) of abnormal Pap and HPV tests using a 3-group study design randomized at the patient level; (i) standard care (SC) plus barriers assessment and counseling delivered via telephone, (ii) SC plus tailored barriers information via home mail, and (iii) SC plus letter notifying patient of abnormal test, the need to undergo colposcopy, an appointment date and telephone appointment confirmation assessment via letter. Numerous patient mediating and moderating measures were included. Patients were 18+ years of age who were tested at a hospital-based women's care center. Intervention was delivered by study staff. The study planned a cost analysis of intervention options.
Interventions strategies targeted at the practice or practice systems level
Strategies in several studies included information technology innovation. Several considered staff re-design (e.g., a cancer prevention specialist\training for interdisciplinary teams, adding a case manager or lay health worker) and staff training (e.g., navigator training women volunteers).Acknowledging that barriers to screening include patient and provider variables, one study designed practice level changes to be implemented within a primary care practice network. The network used an EMR and established specialist referrals. The intervention was a colorectal cancer screening module using a prospective cohort design. Strategies were designed to supplement the existing medical records; the services of a cancer prevention specialist were added to provide education and facilitate ordering and follow-up (in-person, mailings, and phone calls to home).
Intervention strategies aimed at the community level or community organizations
No study tried to change community level factors, but a few involved organizations at the community level. Some studies, however, collected measures at the community level for use in the study design.One study investigated the impact of faith-based lay health advisors on the use of and follow-up to abnormal Pap tests. It used a group randomized (50 religious congregations) experimental design. Formative work included community inventories (e.g., transportation, communication, health resources) to provide information to use in the training of lay advisors who would then talk with women about overcoming barriers.
  • aFrequencies may be greater than 16 because some studies studied more than one strategy.