Guided by the monitoring process model (MPM), the authors explored the illness responses of 2 samples: high monitors (who are cognitively vigilant to and amplify threat-related cues) and low monitors (who avoid them and blunt their impact). Both samples-101 women with human papillomavirus-related precancerous cervical dysplasia and 75 HIV-infected gay men-were undergoing long-term medical follow-up and management. Structural equation analysis showed an adequate fit of the MPM to the data within each sample, supporting the model's heuristic value: High monitors experienced greater disease-related intrusive ideation, which triggered greater avoidant ideation to forestall panic, particularly in the more threatened HIV-positive sample. However, efforts to avoid disturbing intrusive thoughts were ineffective, requiring increasingly extreme defensive strategies (i.e., denial and mental and behavioral disengagement).

Objective Increasing patient knowledge about the value of colorectal cancer (CRC) screening is a goal of most public health education efforts. We hypothesized that a cohort of women at average risk for CRC, but non-compliant with standard screening recommendations, would demonstrate low levels of CRC related knowledge and underestimate their personal risk for developing CRC. Methods Baseline survey results are reported from a prospective trial designed to improve CRC screening participation in women at average risk, but non-complaint with screening recommendations. Women scheduled for a routine gynecological office visit were identified and contacted by telephone approximately 4 weeks before their index appointment. All participants completed a 75 item baseline survey that included items assessing demographic information, CRC knowledge, risk perception and intention to participate in screening. Results Women (n=318) enrolled from June, 2006-May, 2007 are included. Participants demonstrated high levels of CRC and CRC screening related knowledge answering an average of 8.6/10 items correctly (SD 1.30). The majority of these non-compliant women (1) estimated their CRC risk incorrectly (60%) and (2) had no intention of CRC screening participation in the future (65%). Multivariate models found no consistent relationships between knowledge, risk perception, and screening intent. Conclusions Greater “knowledge” alone is an inadequate stimulus to CRC screening adherence. Future interventions will require a greater understanding of the interplay between CRC-related knowledge, beliefs, risk perception, and other affective responses.

Background: New methods to enhance colorectal cancer (CRC) screening rates are needed. The web offers novel possibilities to educate patients and to improve health behaviors, such as cancer screening. Evidence supports the efficacy of health communications that are targeted and tailored to improve the uptake of recommendations.Methods: We identified unscreened women at average risk for CRC from the scheduling databases of obstetrics and gynecology practices in 2 large health care systems. Participants consented to a randomized controlled trial that compared CRC screening uptake after receipt of CRC screening information delivered via the web or in print form. Participants could also be assigned to a control (usual care) group. Women in the interventional arms received tailored information in a high-or low-monitoring Cognitive Social Information Processing model-defined attentional style. The primary outcome was CRC screening participation at 4 months.Results: A total of 904 women were randomized to the interventional or control group. At 4 months, CRC screen-ing uptake was not significantly different in the web (12.2%), print (12.0%), or control (12.9%) group. Attentional style had no effect on screening uptake for any group. Some baseline participant factors were associated with greater screening, including higher income (P=.03), stage of change (P Ͻ.001), and physician recommendation to screen (PϽ .001).Conclusions: A web-based educational intervention was no more effective than a print-based one or control (no educational intervention) in increasing CRC screening rates in women at average risk of CRC. Risk messages tailored to attentional style had no effect on screening uptake. In average-risk populations, use of the Internet for health communication without additional enhancement is unlikely to improve screening participation.

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