Some methodologic lessons learned from cancer screening research

Abstract

Credible and useful methodologic evaluations are essential for increasing the uptake of effective cancer screening tests. In the current article, the authors discuss selected issues that are related to conducting behavior change interventions in cancer screening research and that may assist researchers in better designing future evaluations to increase the credibility and usefulness of such interventions.Selection and measurement of the primary outcome variable (i.e., cancer screening behavior) are discussed in detail. The report also addresses other aspects of study design and execution, including alternatives to the randomized controlled trial, indicators of study quality, and external validity. The authors conclude that the uptake of screening should be the main outcome when evaluating cancer screening strategies; that researchers should agree on definitions and measures of cancer screening behaviors and assess the reliability and validity of these definitions and measures in different populations and settings; and that the development of methods for increasing the external validity of randomized designs and reducing bias in nonrandomized studies is needed.

Multilevel Interventions: Study Design and Analysis Issues

“…Other treatments of multilevel intervention research address measurement issues (28,60), but when assessing predictors or changes at different levels, measurement becomes much more complex than if there is only a single intervention at one level, no assessment of intervening variables, and only patient-level outcomes (61). In our example, if one is interested in the impact of a clinic-level intervention on provider knowledge, and whether clinic changes and provider knowledge are related to screening use, then multiple levels of measurement are necessary.…”

Human papillomavirus and cervical cancer behavioral surveillance in the US

“…These include ever, recency of use (eg, within the past 3 years), and compliance with guidelines (eg, repeat or regular). 62 The range of outcomes measured makes comparisons among studies challenging. Two studies comparing different operational definitions for mammography found that although prevalence estimates varied greatly, the different definitions had little effect on the patterns of association with correlates.…”

“…At a minimum, questionnaires need to provide clear definitions and measures to facilitate interpretation and enable comparisons with other studies. 62 To our knowledge only 2 studies to date have examined the test-retest reliability of self-reported Pap tests. 65,66 Massachusetts BRFSS data showed that nonwhite women reported Pap testing less consistently over time than white women.…”

Mediating Factors in the Relationship between Income and Mammography Use in Low-Income Insured Women

“…The study was conducted in a closed healthcare setting where the outcome could be ascertained through administrative files, eliminating recall bias and overestimation of the outcome commonly found when using self-reported data. 26 …”