The transtheoretical model (TTM) is a commonly applied theoretical perspective for understanding mammography behaviors and improving the effectiveness of one-on-one counseling. The North Carolina Breast Cancer Screening Program (NC-BCSP) developed a training curriculum to incorporate TTM into the advising practices of lay health advisors (LHAs). The TTM helped “natural helper” LHAs understand that women in their rural North Carolina communities were likely to be in different stages for mammography screening and hence required different messages. NC-BCSP staff believed that by combining an understanding of TTM with LHAs’ natural helping abilities we potentially increased the effectiveness of LHA advising. Our limited evaluation, based on LHA feedback, suggests the curriculum is a useful training tool, even for those unfamiliar with behavior change models. Our TTM curriculum serves as an example of a health behavior theory successfully operationalized outside academia for use in the field by lay people.
Abrams, D. B., Boutwell, W. B., Grizzle, J., Heimendinger, J., Sorensen, G., & Varnes, J. (1994). Cancer control at the workplace: The Working Well Trial. Preventive Medicine, 23(1), 15-27.
2.
Altpeter, M., Earp, J. A., Bishop, C., & Eng, E. (1999). Lay health advisor activity levels: Definitions from the field. Health Education and Behavior, 26(4), 495-512.
3.
Baranowski, T., Lin, L. S., Wetter, D. W., Resnicow, K., & Davis Hearn, M. (1997). Theory as mediating variables: Why aren’t community interventions working as desired?AEP, 7(57), S89-S95.
4.
Beam, N., & Tessaro, I. (1994). The lay health advisor model in theory and practice: An example of an agency-based program. Family and Community Health, 17(3), 70-79.
5.
Bird, J. A., McPhee, S. J., Ha, N. T., Le, B., Davis, T., & Jenkins, C. N. (1998). Opening pathways to cancer screening for Vietnamese-American women: Lay health workers hold a key. Preventive Medicine, 27(6), 821-829.
6.
Bishop, C. M., Earp, J. A., Eng, E., & Lynch, K. S. (2002). Implementing a “natural helper” lay health advisor program: Lessons learned from unplanned events. Health Promotion Practice, 3(2), 233-244.
7.
Cabral, R. J., Galavotti, C., Gargiullo, P. M., Armstrong, K., Cohen, A., Gielien, A. C., et al. (1996). Paraprofessional delivery of a theory based HIV prevention counseling for women. Public Health Reports, 111(1), S75-S82.
8.
Campbell, M. K., DeVellis, B. M., Strecher, V. J., Ammerman, A. S., DeVellis, R. F., & Sandler, R. S. (1994). Improving dietary behavior: The effectiveness of tailored messages in primary care settings. American Journal of Public Health, 84(5), 783-787.
9.
Campbell, M. K., Tessaro, I., DeVellis, B., Benedict, S., Kelsey, K., Belton, L., et al. (2002). Effects of a tailored health promotion program for female blue-collar workers: Health works for women. Preventive Medicine, 34(3), 313-323.
10.
Champion, V., & Huster, G. (1995). Effect of interventions on stage of mammography adoption. Journal of Behavioral Medicine, 18(2), 169-187.
11.
Champion, V. L. (1994). Beliefs about breast cancer and mammography by behavioral stage. Oncology Nursing Forum, 21(6), 1009-1014.
12.
Cheney, R., & Merwin, A. (1996). Integrating a theoretical framework with street outreach services: Issues for successful training. Public Health Reports, 111(1), S83-S87.
13.
Clark, M. A., Rakowski, W., Ehrich, B., Rimer, B. K., Velicer, W. F., Dube, C. E., et al. (2002). The effect of a stage-matched and tailored intervention on repeat mammography. American Journal of Preventive Medicine, 22(1), 1-7.
14.
Earp, J. A., Altpeter, M., Mayne, L., Viadro, C. I., & O’Malley, M. S. (1995). The North Carolina Breast Cancer Screening Program: Foundations and design of a model for reaching older, minority, rural women. Breast Cancer Research and Treatment, 35(1), 7-22.
15.
Earp, J. A., & Flax, V. L. (1999). What lay health advisors do: An evaluation of advisors’ activities. Cancer Practice, 7(1), 16-21.
16.
Earp, J. A., O’Malley, M. S., Altpeter, M., Rauscher, G., Mayne, L., Mathews, H. F., et al. (2002). Increasing use of mammography among older rural, African American women: Results from a community trial. American Journal of Public Health, 92(4), 646-654.
17.
Eng, E., & Smith, J. (1995). Natural helping functions of lay health advisors in breast cancer education. Breast Cancer Research and Treatment, 35(1), 23-29.
18.
Erwin, D. O., Spatz, T. S., Stotts, R. C., & Hollenberg, J. A. (1999). Increasing mammography practice by African American women. Cancer Practice, 7(2), 78-85.
19.
Hochbaum, G. M., Sorenson, J. R., & Lorig, K. (1992). Theory in health education practice. Health Education Quarterly, 19(3), 295-313.
20.
Holli, B. B., & Calabrese, R. J. (1998). Principles and theories of learning. In Communication and education skills for dietetics professionals (pp. 137-148). Philadelphia: Williams and Wilkins.
21.
Israel, B. A. (1985). Social networks and social support: Implications for natural helper and community level interventions. Health Education Quarterly, 12(1), 65-80.
22.
Jackson, C. (1997). Behavioral science theory and principles for practice in health education. Health Education Research, 12(1), 143-150.
23.
Jackson, E. J., & Parks, C. P. (1997). Recruitment and training issues from selected lay health advisor programs among African Americans: A 20-year perspective. Health Education and Behavior, 24(4), 418-431.
24.
Kreuter, M., & Skinner, C. (2000). Tailoring: What’s in a name? [Comment]. Health Education Research, 15(1), 1-4.
25.
Kreuter, M. W., Strecher, V. J., & Glassman, B. (1999). One size does not fit all: The case for tailoring print materials. Annals of Behavioral Medicine, 21(4), 276-283.
26.
Legler, J., Meissner, H. I., Coyne, C., Breen, N., Chollette, V., & Rimer, B. K. (2002). The effectiveness of interventions to promote mammography among women with historically lower rates of screening. Cancer Epidemiology, Biomarkers, and Prevention, 11(1), 59-71.
27.
Lipkus, I. M., Rimer, B. K., Halabi, S., & Strigo, T. S. (2000). Can tailored interventions increase mammography use among HMO women?American Journal of Preventive Medicine, 18(1), 1-10.
28.
Mandelblatt, J., & Yabroff, K. (1999). Effectiveness of interventions designed to increase mammography use: A meta-analsysis of provider targeted strategies. Cancer Epidemiology, Biomarkers, and Prevention, 8, 759-767.
29.
Marcus, A. C., Bastani, R., Reardon, K., Karlins, S., Das, I. P., Van Herle, M. P., et al. (1993). Proactive screening mammography counseling within the Cancer Information Service: Results from a randomized trial. Journal of the National Cancer Institute Monographs, (14), 119-129.
30.
Meissner, H. I., Breen, N., Coyne, C., Legler, J. M., Green, D. T., & Edwards, B. K. (1998). Breast and cervical cancer screening interventions: An assessment of the literature. Cancer Epidemiology, Biomarkers, and Prevention, 7(10), 951-961.
31.
North Carolina Breast Cancer Screening Program. (2001). April 2001 focus group report. Chapel Hill: University of North Carolina Lineberger Comprehensive Cancer Center.
32.
Paskett, E. D., Tatum, C. M., D’Agostino, R., Jr., Rushing, J., Velez, R., Michielutte, R., et al. (1999). Community-based interventions to improve breast and cervical cancer screening: Results of the Forsyth County Cancer Screening (FoCaS) Project. Cancer Epidemiology, Biomarkers, and Prevention, 8(5), 453-459.
33.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395.
34.
Prochaska, J. O., Redding, C. A., & Evers, K. E. (2002). The transtheoretical model and stages of change. In K. Glanz, F. M. Lewis, & B. K. Rimer (Eds.), Health behavior and health education: Theory, research and practice (3rd ed., pp. 99-120). San Francisco: Jossey-Bass.
35.
Rakowski, W., Andersen, M. R., Stoddard, A. M., Urban, N., Rimer, B. K., Lane, D. S., et al. (1997). Confirmatory analysis of opinions regarding the pros and cons of mammography. Health Psychology, 16(5), 433-441.
36.
Rakowski, W., Dube, C. E., Marcus, B. H., Prochaska, J. O., Velicer, W. F., & Abrams, D. B. (1992). Assessing elements of women’s decisions about mammography. Health Psychology, 11(2), 111-118.
37.
Rakowski, W., Ehrich, B., Dube, C. E., & Pearlman, D. N. (1996). Screening mammography and constructs from the transtheoretical model: Associations using two definitions of the stages-of-adoption. Annals of Behavioral Medicine, 18(2), 91-100.
38.
Rakowski, W., Ehrich, B., Goldstein, M. G., Rimer, B. K., Pearlman, D. N., Clark, M. A., et al. (1998). Increasing mammography among women aged 40-74 by use of a stage-matched, tailored intervention. Preventive Medicine, 27(5 Pt 1), 748-756.
39.
Richards, C. L., Viadro, C. I., & Earp, J. A. (1998). Bringing down the barriers to mammography: A review of current research and interventions. Breast Disease, 10(3,4), 1-12.
40.
Rimer, B., Halabi, S., Skinner, C., Kaplan, E., Crawford, Y., Samsa, G., et al. (2001). The short-term impact of tailored mammography decision-making interventions. Patient Education and Counseling, 43(3), 269-285.
41.
Rimer, B. K., Halabi, S., Sugg Skinner, C., Lipkus, I. M., Strigo, T. S., Kaplan, E. B., et al. (2002). Effects of a mammography decision-making intervention at 12 and 24 months. American Journal of Preventive Medicine, 22(4), 247-257.
42.
Skinner, C. S., Campbell, M. K., Rimer, B. K., Curry, S., & Prochaska, J. O. (1999). How effective is tailored print communication?Annals of Behavioral Medicine, 21(4), 290-298.
43.
Skinner, C. S., Sykes, R. K., Monsees, B. S., Andriole, D. A., Arfken, C. L., & Fisher, E. B. (1998). Learn, share, and live: Breast cancer education for older, urban minority women. Health Education and Behavior, 25(1), 60-78.
44.
Smith, M. U., & DiClemente, R. J. (2000). STAND: A peer educator training curriculum for sexual risk reduction in the rural South. Preventive Medicine, 30, 441-449.
45.
Steckler, A., Allegrante, J. P., Altman, D., Brown, R., Burdine, J. N., Goodman, R. M., et al. (1995). Health education intervention strategies: Recommendations for future research. Health Education Quarterly, 22(3), 307-328.
46.
Stoddard, A. M., Rimer, B. K., Lane, D., Fox, S. A., Lipkus, I., Luckmann, R., et al. (1998). Underusers of mammogram screening: Stage of adoption in five U.S. subpopulations. The NCI Breast Cancer Screening Consortium. Preventive Medicine, 27(3), 478-487.
47.
Sung, J. F., Blumenthal, D. S., Coates, R. J., Williams, J. E., Alema-Mensah, E., & Liff, J. M. (1997). Effect of a cancer screening intervention conducted by lay health workers among inner-city women. American Journal of Preventive Medicine, 13(1), 51-57.
48.
University of Arizona. (1998). A summary of the National Community Health Advisor Study. Tucson, AZ: Annie E. Casey Foundation.
49.
van Ryn, M., & Heaney, C. A. (1992). What’s the use of theory?Health Education Quarterly, 19(3), 315-330.
