Health screen feedback prompts medical follow-up visits among physically active senior adults.

Abstract: This pre-test, post-test quasi-experimental study determined if the self-perceived value of requested health material helps prompt older adults to schedule an appointment with a clinical care provider given potential risk factors identified from routine screening results. Senior adult participants (aged 50-90) were recruited purposively at the World Senior Games and were randomly assigned to a comparison group or one of two treatment groups. Post-test comparisons and conclusions include: a) providing tailored communication feedback increases the likelihood that physician follow-up occurs, and b) health screening follow-up should involve determining individual message channel preferences in order to prompt specific, desirable behaviors.

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Although diversity is a hallmark of the senior population, some changes do accompany aging, and even healthy seniors experience losses that can affect their access, level of interest and/or capacity to receive and understand information (Public Health Agency of Canada, 2005). According to Healthy People 2010, health communication and marketing skills are important to deliver appropriate disease prevention and health promotion practices among various populations. However, among the more important practices include identifying preferred communication channels for diverse populations in various settings and levels regarding gender, race, ethnicity, education, or income. These variables form profiles that aid practitioners in more effectively influencing the behaviors of target audiences (U.S. Department of Health and Human Service [USDHHS], 2000). Among populations for which communication preferences are least understood are among senior adults (Hines, Moss, & Badzek, 1997). Projections for demographic growth are highest among seniors as compared to all age groups. Census Bureau data (2004) projects that populations aged 65 and older will double over the next three decades from 35.3 million to nearly 70 million. Further, as America ages, persons with chronic conditions will increase dramatically. Fortunately, health screenings for various chronic conditions have helped to prolong lives and reduce disabling chronic conditions (USDHHS, 2000; Woolf, Kamerow, Lawrence, Medalie, & Estes, 1990).

Researchers have identified the primary outcome of screening for various risk factors is reductions in the risk of premature death (Nelson et al., 2002). Screenings are relatively inexpensive and help identify risk conditions and thus play a role for health promotion practitioners in reducing at-risk behaviors (or promoting positive behaviors) among groups and individuals in the short-term (Strecker & Krueter, 2000; Anderson & Staufacker, 1996). Since screenings are nondiagnostic and primarily educational in nature, the greatest opportunities associated with screenings are the follow-up education, communication, referrals and behavioral prescriptions that are provided soon after the test results are available to the screening participant.

One of the more important prevention activities for seniors is health screening coupled with appropriate follow-up activities. An ideal component of follow-up includes receiving follow-up advice in person or in writing, visiting with a physician to receive further confirmatory testing, and other sustained consultations regarding a given disease (American Geriatrics Society Ethics Committee [AGSEC], 2003; Beck, 1999). Based on that ideal, health educators and health care providers continue to promote screening tests and also provide important follow-up on the basis of the test results to encourage appropriate medical diagnosis, treatment and preventive services, and lifestyle changes. An important part of understanding willingness to comply among participants of health screening with lifestyle advice and to seek out health services is dependent upon health educators knowing about older adult preferences for receiving follow-up information. Of the many approaches used to identify consumer preferences in research, nearly all focus is on health communication channel preferences.

According to Fried, Rosenberg and Lipsitz (1995), some older adults seek out such screening activities and frequently report visiting with their physician after obtaining their results. However, according to the same authors, making informed lifestyle decisions and complying with recommendations from these follow-up activities are not well researched. Hines and colleagues (1997) found that these follow-up activities are improved when effective mechanisms of communication are delivered or made available. Specifically, screening participants are more willing to comply with treatment recommendations, possess better understanding of self-care practices needed to preserve or restore good health, and more willing to speak to their health care provider about their health when effective communication mechanisms or behaviors are used. In their study conclusions, Hines and colleagues found that older adult screening participants prefer being informed of their potential risks and to learn of options in more ways than being involved with medical decision makers (Hines et al., 1997). Thus, follow-up patterns and communication practices must be known to adapt to the expectations of older adults and influence compliance to clinical recommendations or regimens.

The purpose of this study is to determine if older adult preferences for health communication materials prompt appropriate follow-up on risk factors after health screens are conducted among older adults. Additionally, this pre-test, post-test quasi-experimental study seeks to identify if the self-perceived value of requested health material helps prompt older adults to schedule an appointment with a clinical care provider given potential risk factors identified from routine screening results.

METHOD PARTICIPANTS AND SCREENING

Senior adult participants (aged 50-90) were purposively recruited at the World Senior Games in St. George, Utah. Seniors participated in leisure sports including lawn bowling and rigorous sports such as basketball, swimming and triathlon events. Approximately one-third of athletes participate in health screenings (personal communication, Oct, 2004). The participants in the Huntsman World Senior Games come primarily from pacific and mountain states (56%), with the remaining participants coming from contiguous states (34%) and 10% foreign countries (personal communication, Oct, 2004).

A wide variety of health screenings were an optional, free of charge activity to all athletes and non-competing partners during the week-long game events. These screenings include cholesterol, glucose, glaucoma, hypertension, body composition, bone density, cancer, hearing, and prostate-specific antigen (PSA) screenings.

All screening participants either received their results at the time of screening or, in the case of cholesterol, PSA, and blood sugar, were sent their results by mail from a clinical laboratory within approximately 3-4 weeks.

BASELINE QUESTIONNAIRE

When the Senior Games participants entered the St. George Civic Center to receive one or more free screening tests, they were invited to sign a consent form to participate and then complete a short questionnaire. The questionnaire was administered orally by trained researchers where one assistant asked each question and another recorded their responses. This was done to assure efficiency and to reflect the oral-nature of a follow-up questionnaire that would be conducted during a telephone contact after the screening was completed. This baseline questionnaire asked questions about their sex, age, race, education, marital status, history of comorbid conditions, and time since last visited a doctor for a routine checkup. Two questions about preferred types of health communication materials were also asked to ascertain the appropriate form of follow up information each participant wished to receive relative to their screening results, in addition to whether they would be willing to let us contact them by mail or telephone to ask follow-up questions. Prior to screenings and before human subjects approval was granted, content validity was assessed through a panel of six experts representing medical and clinical services, and gerontology and public health disciplines. At least 90% agreement was obtained for each item regarding the wording and measurement parameters.

TREATMENT GROUPS AND INTERVENTION MATERIAL

A pre-test, post-test quasi-experimental research design was used in making comparisons between control and treatment groups. Those individuals willing to be contacted later by telephone and who possessed positive screen results (for selected risk factors) were randomly assigned to either a control group or one of two treatment groups. There were 721 individuals who completed the questionnaire at the time of the screenings (pre-test). Of this number, 475 (65.9%) indicated that they were willing for us to contact them further by mail or telephone with additional questions. These individuals were randomly assigned to two treatment groups (who received mailed follow-up material according to participants stated communication preference) and a control group as identified above. Numbers of subjects randomly assigned to each of the three groups were: 189 in Treatment Group 1 (T1), 131 in Treatment Group 2 (T2), and 155 in the control group. Approximately 15 participants assigned to T2 were inadvertently mailed the personalized and tailored screening follow-up material so the investigators reallocated these participants into T1.

Both treatment groups were sent communication products given the condition being screened and according to their stated channel preference in the initial questionnaire. In addition, T1 was sent tailored information about their screening results. Members of this group were reminded of their screening results and how these results related to personal risk behaviors for the given health condition. On the basis of previous research on message tailoring, specific suggestions for clinical follow up were also provided as a part of tailoring the message for T1 (Campbell et al., 1994). T2, as stated earlier, only received the communication products according to their stated preference in the baseline questionnaire, with no additional information or prompts about their individual screening results. The control group did not receive any material related to their health or screening. This group only received the follow up telephone call at post-test.

The communication products selected for the treatment group recipients were based on health communication channel preferences (Rimer & Glassman, 1998; Schooler, Chaffee, Flora, and Rosa, 1998). The following products were identified for older adults given each screening topic (blood sugar, osteoporosis, body mass composition, cancer, breast cancer, blood pressure, cholesterol, prostate cancer): pamphlets, scientific/ medical articles, videotapes, Internet URLs, expert written books, informational television program recordings, radio programs, and newspaper articles. These materials reflected the list of communication channels from which participants selected their preference choice.

The selection process for purchasing these materials involved conducting thorough literature reviews in journals, compiling lists from brochure, videotape, book publisher and broadcast corporations according to senior adult characteristics. Next, the lists of products by screening topics were presented to six expert panelists (identified earlier), asking them to identify their top three choices for each. Using the reviewers' prioritized lists and given the availability and price of items, sufficient quantities of materials were ordered. Once all materials were available, the specific materials requested by screening topics were sent to treatment group recipients (T1 & T2), a process taking approximately seven weeks.

FOLLOW-UP QUESTIONNAIRE

After sufficient time had passed (2 to 3 weeks) to receive the mailed material and read and attend to its messages, all participants from the designated treatment and control groups were contacted using CATI (computer assisted telephone interviewing) technologies. They were also asked to identify their communication preference should future material be requested or made available to them. Control group participants were not asked questions regarding satisfaction with the material but were asked to identify their communication preference should future material be requested or made available to them. Among T1 & T2 participants, the follow-up questionnaire (post-test) also assessed whether they reviewed the material sent and their satisfaction with the material.

The timing of the telephone follow-up questionnaire allowed for screening results to be returned from the lab, the panel of expert to conduct a content validity assessment of the follow-up questionnaire, order and organize materials and to pilot test of the telephone follow up procedures. A pilot test for the telephone follow-up consisted of randomly selected treatment group participants (n=75), with the average telephone conversation lasting approximately 12 minutes. Based on the validity assessment and pilot test results, the identified panel of experts made several minor changes in item wording and the introductory salutation to improve efficiency and simplicity.

Telephone contacting occurred for approximately one month with the maximum average attempted telephone contacts not exceeding seven calls per person. The CATI system tracked and organized the call backs and follow-up attempts. Non respondents included those having wrong telephone numbers (20), those refusing to participate (30), or unsuccessful attempted callbacks that exceeded seven calls (81).

DATA

Compared to the 475 pre-test participants willing to be contacted them for post-test follow-up, completed follow-up questionnaires were obtained from 344 (72.4%) of these individuals (149 in T1, 92 in T2, and 103 in the control group). Considering all potential participants from the initial assessment through random assignment and follow-up assessments, the response rate was 47% (344/721). Analyses are based on these 344 individuals.

The statistical methods used for analysis included the following Statistical Analysis System (SAS) software procedures: Parametric and nonparametric techniques used to address the nominal, ordinal and continuous variables; contingency tables; chi-square tests for independence and trends; multiple polytomous logistic regression; multiple dichotomous logistic regression; and multiple regression were used. All tests of significance were based on the 0.05 level.

RESULTS

Frequency distributions of select characteristics are presented in Table 1. Subjects ranged in age from 50 to 88 years. Their self-described general health was primarily excellent or very good: 36.1% excellent, 45.6% very good, 16.0% good, 2.0% fair, and 0.3% poor. Average screening scores were 213.6 (n = 318, standard deviation [SD] = 36.3) for cholesterol, 133.7 (n = 277, SD = 16.5) for systolic blood pressure, 83.3 (n = 277, SD = 9.8) for diastolic blood pressure, 104.0 (n = 218, SD = 41.3) for blood sugar, 26.6 (n = 175, SD = 3.4) for body mass index, and 0.06 (n = 170, SD = 1.3) for bone density.

There were no statistically significant associations between preferences for health communication channels and age, sex, marital status, comorbid disease status, or length of time since last visited a doctor. On the other hand, there was a negative association between health communication channels and personal communication channels, both ranked from easiest readability/ least time requirement to most difficult readability/ time requirement (Mantel-Haenszel ~2=6.6, p = 0.0105). For example, of the individuals who specified a pamphlet or brochure as most preferred, 1.8%, 4.9%, 16.5%, and 76.8% expressed interest in a onetime health seminar in their community, an on-going health seminar in their community, a one-on-one telephone consultation with a health care professional, and a one-on-one consultation with a health care professional, respectively. For individuals specifying a scientific or medical article as most preferred, corresponding percentages across personal communication channels were 7.8%, 6.5%, 20.8%, and 64.9%.

Although all individuals that underwent screening received their screening results, T1 also received specific recommendations, explanations and directive information regarding their screening results and the importance for confirmatory diagnoses by their health care provider. Unlike T2 and the control group, T1 participants received tailored information about the relative risks for each of their clinical measures similar to the detailed results provided by the better health risk appraisal. Individuals in this group were compared with the other subjects according to their opinion about whether their screening results identified skills they could use to change their behavior, and whether it was easy to understand and of appropriate quality. T1, T2 and the control group participants were asked whether a change in health behavior was made as a result and if not, why not, and the extent that any of their doctor visits since the World Senior Games had been a result of the screening results received.

The tailored screening information from T1 did not statistically prompt behavior change responses. Nearly one third (32.5%) of the participants indicated they changed their health behavior as a result of the screening material. Of the 67.5% who did not change their health behavior, the primary reason given for not changing their behavior was because they were already engaged in the health behavior (74.6%). In addition, the degree any of their doctor visits since the World Senior Games had been a result of the screening results involved about 43% (i.e., 8.5% completely influenced, 9.5% mostly influenced, 24.0% somewhat influenced, and 57.2% influenced not at all). An additional 0.7% did not know whether they went to the doctor for their identified risk factor.

Among treatment participants, there were 191 individuals who responded to a question asking how much of the mailed material they reviewed. Responses to this question were as follows 39.3% read all of it, 13.6% read most of it, 11.5% read some of it, 15.2% read none of it, and 4.2% did not receive the material. Based on dichotomous logistic regression where reviewed (all, most, or some versus none) was regressed on age, sex, race, marital status, education, comorbid disease, and type of material sent, only age (marginally insignificant), sex, comorbid disease, and type of material sent contributed to the fit of the model (Table 2). Younger age, being a man, and having comorbid conditions were positively associated with reviewing the material. Individuals receiving a suggested internet URL site were less likely to review the material compared with receiving an in-hand scientific or medical article.

Among those who reviewed some or all of the material sent them, only 14 (6.0%) indicated that they would change their original health communication channel preference, and 15.2% among the control group indicated a change in channel preference. Nevertheless, this difference was not statistically different (~2=2.01, p = 0.1567). Twelve of the 14 respondents who indicated that they would change their preference had a history of comorbid disease. There was no difference between these two groups in whether the information received was motivating (Chi-square 0.82, p = 0.9355). Yet in response to whether the information was motivating toward behavior change, 24.4% strongly agreed, 51.2% agreed, 20.3% disagreed, and 1.6% strongly disagreed. There were 2.4% who did not know. The slightly higher percentage of persons who changed their channel preference among the control group is explained to some degree by the fact that no material (channel specific or otherwise) was sent to them that may have influenced or reinforced their originally stated preference.

To determine if educational attainment influenced an adult senior's preference for in depth message channels, the researchers ordered the various channel options according to the depth of information, difficulty of understanding, and time investment needed to attend to the message communicated by considering the work of Schooler and colleagues (1998). Participants with higher education preferred those message channels that possessed a greater depth of information and time investment, while those with lower educational attainment preferred the more simple and easy types of channels.

The relation between screening scores and having reviewed the material was also assessed. The scores for each of the screening variables, assessed one at a time using regression techniques, were not statistically associated with whether the mailed material requested was reviewed.

DISSCUSSION

Although adult seniors preferred a wide range of health message sources, they generally maintained their original preferences for health communication channels (e.g., those who liked scientific articles before screening continued to value that preference after they received and reviewed it even though their risk factors increased). In fact, of those who reviewed the received material, only 17 seniors (0.05%) identified a preference for a different communication channel. Health promotion planners should provide adult seniors with multiple message channel options when communicating health screening information and then continue follow-up with their selected channel. This consistency of preference is supported by previous research (Lefebvre & Rochlin, 1997) and is especially important if it prompts physician follow-up among adult seniors. Further these general findings are consistent with theoretical and models for behavior change because of the recognized relation between beliefs, attitudes, intentions and behaviors Glanz & Rimer, 1995; Glassman & Rimer, 1999). Important findings and lessons from this study are summarized in Figure 1.

[FIGURE 1 OMITTED]

Although only 17 persons (0.05%) stated a preference for a different message channel option from pre-test to post-test, it is important to consider possible reasons for preference changes. For this study, adult seniors may have considered identifying a new preference because a) they could not remember what they requested earlier and stated whatever sounded good for the moment; b) they attempted to read, listen to, or watch the mailed material but found it not interesting or not relevant; or c) they read, listen to, or watch the mailed material and learned from it but are now interested in learning more through alternate methods. Because of these and potentially other reasons, only a handful of participants selected different message channels between the intake survey and the follow-up telephone survey. Note, the researchers did not remind the participants of their originally stated channel preference when they were asked what their communication preference was during the post-test. It can be assumed that most participants valued the message form sent for them. This observation helps highlight an important lesson: when adult seniors are presented with channel options, they know what type they want, can identify the best channel option for them, generally value and act positively from the message provided, and often take preventive actions as suggested by their screening results. Therefore, adult seniors generally retain a consistency in their communication preferences. As a result, adult seniors should be given the opportunity to select message option preference from a variety of message delivery channels when HRA feedback or follow-up interventions are planned.

Matching communication preferences with screening feedback prompted 20 percent of treatment participants' to receive health care visits based on their screening results. An additional 25 percent indicated that communication material somewhat influenced a visit with their health care professional. This finding among treatment participants supports the importance of health communication channel preferences in secondary prevention and other health promotion activities relating to health screening follow-up interventions. Therefore, this study provides promise that health risk appraisal feedback and health communication-based follow-up is effective in prompting physician follow-up visits and confirmatory diagnosis activities. These findings are also congruent with employee-based health promotion programs (Anderson & Staufacker, 1996) and with federal-sponsored research through the National Cancer Institute (1998).

Another key study insight regarding communication channel preferences among senior adults is that education level influenced whether the material was reviewed. As noted above, participants with higher education preferred materials with a greater depth of information and time investment, while those with lower educational attainment preferred the more simple and easy types of materials. Thus, adult seniors need access to education-specific material options to self-select appropriate and realistic channels they prefer. Further, adult seniors tend to find their educational level match and this selection affects their willingness to review the feedback material. Clearly, public health educators must be concerned with understanding consumer preferences and influencing behavioral adherence using audience analysis techniques including social marketing or health communication.

While the results of this study raise important insights into the communication preferences and practices of active senior adults, this study has limitations that affect the generalizability of its findings. First, the sample under study was self-selected and was of limited size. Most participants were relatively homogenous, physically active older adults, Caucasian, and well-educated. These characteristics are not inferable to all seniors. There is a need for future studies to consider more diverse populations of seniors. Second, the cross-sectional nature of the study did not incorporate longitudinal trends. Such investigations in the future would allow researchers to assess the effect of lifestyle changes, screening results, comorbid identifiers, etc. to communication preferences over time.

In summary, older adults respond very well to health material that reflects their identified channel preference. Slightly less than half of treatment participants were prompted to seek follow-up medical visits after receiving physiologic screening results along with preferred channels of feedback materials. Targeted interventions involving communication channel options must be based upon older adult channel preferences and should reflect diverse delivery options and communication sources. This fact underscores the importance of conducting careful audience analysis and social marketing research to effectively reach older adults. Clearly, determining and using health communication channel preferences to provide health screening feedback and follow-up are important health promotion intervention components to enhance disease prevention among older adults who are physically active.

REFERENCES

American Geriatrics Society Ethics Committee [AGESEC], (2003). Health screening decisions for older adults: AGS position paper. Journal of the American Geriatrics Society, 51, 270-271.

Anderson, D.R., & Staufacker, M.J. (1996). The impact of worksite-based health risk appraisal on health-related outcomes: A review of literature. American Journal of Health Promotion, 10, 499.

Beck, L.H. (1999). Periodic health examination and screening test in adults. Hospital Practice, 34, 117-126.

Campbell, M. K., DeVellis, B. M., Strecher, V. J., Ammerman, A. S., DeVellis, R. F., & Sandler, R. S. (1994). The impact of message tailoring on dietary behavior change for disease prevention in primary care settings. American Journal of Public Health, 84, 783-787.

Fried, T.R., Rosenberg, R.R., & Lipsitz, L.A. (1995). Older community-dwelling adults' attitudes toward and practices of health promotion and advance planning activities. Journal of the American Geriatrics Society, 43(6), 645-649.

Glanz, K., & Rimer, B. K. (1995). Theory at a glance: A guide for health promotion practice (NIH Publication No. 97-3896). Bethesda, MD: National Cancer Institute.

Glassman, B. & Rimer, B. K. (1999). Is there a use for tailored print communications in cancer risk communications? [Monograph]. Journal of the National Cancer Institute, 25.

Hines, S.C., Moss, A.H., & Badzek, L. (1997). Being involved or just being informed: Communication preferences of seriously ill, older adults. Communication Quarterly, 45(3), 268-281.

Lefebvre, R. C., & Rochlin, L. (1997). Social marketing. In K. Glanz, F. M. Lewis, & B. K. Rimer (Eds.), Health behavior and health education: Theory, research, and practice (2nd ed.). San Francisco: Jossey-Bass.

National Cancer Institute. (1998). How the public perceives, processes, and interprets risk information: Findings from focus group research with the general public. Rockville, MD: U.S. Department of Health and Human Services.

Nelson, D.E., Bland, S., Powell-Griner, E., Klein, R., Wells, H.E., Hogelin, G., et al. (2002). State trends in health risk factors and receipt of clinical preventive services among US adults during the 1990s. Journal of the American Medical Association, 287(20), 2659-2667.

Public Health Agency of Canada, (2005). Communicating with seniors (n.d.). The senior audience: Large, growing and diverse. Retrieved March 2005, from http://www.phac-aspc.gc.ca/seniors-aines/pubs/communicating/ audience_e.htm.

Rimer, B. K., & Glassman, B. (1998). Tailoring communications for primary care settings. Methods of Information in Medicine, 37(3), 171-177.

Schooler, C., Chaffee, S. H., Flora, J. A., & Roser, C. (1998). Health campaign channels: Tradeoffs among reach, specificity, and impact. Human Communication Research, 24, 410-432.

Schweitzer, S.O., Atchison, K.A., Lubben, J.E., Mayer-Oakes, S.A., DeJong, F.J., & Matthias, R.E., (1994). Health promotion and disease prevention for older adults: Opportunity for change or preaching to the converted? American Journal of Preventive Medicine, 10(4), 223-229.

Strecher, V.J., & Kreuter, W.W. (2000). Health risk appraisal from a behavioral perspective: Present and future. International Electronic Journal of Health Education, 3, 169.

Woolf, S.H., Kamerow, D.B., Lawrence, R.S., Medalie, J.H., & Estes, E.H., (1990). Periodic health examination of older adults: The recommendations of the U.S. preventive services task force. Journal of the American Geriatrics Society, 38, 8-17-823.

U.S. Department of Health and Human Services, (2000). Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office.

CHES AREAS

I. Assess Needs A. Obtain data about needs and interests

III. Implement Health Education Programs C. Select methods/media suited to audience

VI. Act as ResourcePerson in Health Education D. Select effective education resources to disseminate 

VII. Communicate Findings D. Foster communication between health care providers and consumers

Michael D. Barnes, Ph.D., CHES, Ray M. Merrill, Ph.D., MPH, and Steven W. Heiner, Ed.D. are Professors in the Department of Health Science at Brigham Young University. Deborah D. Lee, MPA is a Policy and Economic Analyst at Mercer. Address all correspondence to Michael D. Barnes, Ph.D., CHES, Department of Health Science, 213 Richards Building, Brigham Young University, Provo, UT 84602. PHONE: [phone]; FAX: [phone]; E-MAIL: [e-mail].

Table 1. Frequency distribution of selected factors.

                                                Number     Percentage

Age                                              344            65.0
                                                            (average)
Sex
  Men                                            221            65.8%
  Women                                          115            34.2%

Race
  Caucasian                                      329            95.6%
  Other                                           15             4.4%

Education
  Less than HS                                    17             5.0%
  HS                                              64            18.7%
  Some college                                   105            30.7%
  Bachelor degree                                 81            23.7%
  Graduate degree                                 75            21.9%

Marital Status
  Married                                        308            89.5%
  Not married                                     36            11.5%

Comorbid disease *
  Yes                                            193            56.1%
  No                                             151            43.9%

Last Visited a Doctor for a Routine Checkup
  1-12 months ago                                253            73.6%
  1-2 years ago                                   52            15.1%
  2-5 years ago                                   30             8.7%
  Do not know/not sure                             7             2.0%
  Never                                            2             0.6%

Most Preferred Additional Information Related to Screening Results
  Informational television program                 3             0.9%
    on subject
  Newspaper article on the subject                 4             1.2%
  Radio program on the subject                     2             0.6%
  Pamphlet or brochure on the subject            165            48.5%
  Video tape on the subject                       31             9.1%
  Internet search or access specific URL          25             7.4%
  An information-based computer program           14             4.1%
  Book on the subject                             19             5.6%
  Scientific or medical article on                77            22.6%
   the subject

Most Preferred Additional Information Related to Screening
Results--Personal Communication

  Attend a one-time health seminar                15             4.4%
  in community

  Attend an on-going health seminar               15             4.4%
  in community

  One-on-one telephone consult w/ a               66            19.3%
  health care professional (MD or RN)

  One-on-one consult w/ a health care            246            71.9%
  professional (MD or RN)

* Comorbid disease is present if the participants indicated that they
had ever been told by a doctor or other health professional that
they had one or more of the following: cancer, heart disease,
diabetes, glaucoma, arthritis, lung disease, high
blood pressure, osteoporosis, or prostate disease.

Table 2. Odds ratios and 95% confidence intervals of review of material
(yes vs. no) according to age, sex, comorbid disease, and
material sent.

                                    Odds Ratio     95% Confidence
                                                      Interval

Age (increasing)                       0.96          0.91, 1.01
Sex (women vs. men)                    0.46          0.23, 0.92
Comorbid disease (yes vs. no)          2.23          1.16, 4.30
Material Sent
  Scientific or medical article        1.00           Referent
  Book                                 1.41          0.24, 8.40
  Internet site                        0.10          0.03, 0.38
  Video tape                           0.67          0.18, 2.49
  Pamphlet                             0.50          0.21, 1.16
  Newspaper article                     *                 *

Bold type indicates significance at .05

* Insufficient numbers to compute.

Figure 1. Key Findings and Implications for Practitioners

Key Findings

* Recipients of tailored messages are more likely to review the message
and less likely to prefer another message channel

* A tailored response increases the likelihood that diagnoses and
physician follow-up occurs

* Channels for screening feedback is related to having a 'direct
influence' or 'somewhat influence' to secure follow-up visits with
health professionals

* Higher educated participants choose channels that contain more
in-depth information and require more time investment; they are also
more likely to review the message

* Senior athletes are more likely to attend to health messages than
non-athletes

* Adult seniors know what channel option they want and what is best for
them

Implications for Practitioners

* Adult seniors should be provided multiple message channel options
when communicating health screening follow-up information

* Health screening follow-up/educational outreach should involve
determining individual message channel preferences

* Adult seniors should be given the opportunity to select their
preference for message options from a variety of message delivery
channels