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J Cockburn

Publications and source records attributed to J Cockburn.

At least 73 records · Page 4Linked to original sources
PubMed1992

Effectiveness, costs, and cost-effectiveness of recruitment strategies for a mammographic screening program to detect breast cancer.

BACKGROUND AND PURPOSE: Since effective and affordable recruitment methods are essential for the widespread implementation of mammographic screening for detection of breast cancer, we studied the effectiveness, the costs, and the cost-effectiveness of various recruitment strategies in the population targeted by a pilot Australian program that offered free mammography screening between 1988 and 1990. METHODS: We evaluated three public recruitment strategies--local newspaper articles, community promotion, and promotion to physicians--and five personal strategies--invitation letters with or without specified appointment times, either alone or with a follow-up letter, or telephone call to nonattenders. The effectiveness of public recruitment strategies was estimated from monthly attendance rates by Poisson regression analysis, while the probability of attendance in response to personal strategies was calculated using logistic regression analysis. Costs were determined by resource usage studies. The cost-effectiveness ratios for personal strategies were determined using decision analysis. RESULTS: The costs in 1988-1989 Australian dollars per woman recruited were $22 for local newspaper articles and $106 for community promotion. No detectable increase in attendance resulted from promotion to physicians. When the cost of reserving an appointment was considered, the most cost-effective personal recruitment strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders. This strategy recruited 35.6% of women in the sample targeted and cost $10.52 per attendee. In comparison, the most effective personal recruitment strategy was a letter with a specified appointment time followed by a second letter to nonattenders, which recruited 44.1% of women at an average cost of $19.99 and a marginal cost of $59.71 per additional attendee. CONCLUSIONS: Personal recruitment strategies were more cost-effective than public strategies. The most cost-effective personal strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders.

Australia↗
PubMed1992

Randomised trial of three approaches for marketing smoking cessation programmes to Australian general practitioners.

OBJECTIVE: To compare three approaches for marketing a quit smoking intervention kit to general practitioners. DESIGN: Randomised trial of (a) personal delivery and presentation by an educational facilitator with a follow up visit six weeks later; (b) delivery to the receptionist by a friendly volunteer courier with a follow up phone call six weeks later, or (c) postal delivery with a follow up letter six weeks later. SETTING: Melbourne, Australia. SUBJECTS: 264 randomly selected general practitioners. DATA COLLECTION: A research assistant visited each doctor four months after delivery and measured use of components of the kit. A questionnaire measuring perceptions of aspects of the kit and its delivery was completed by doctors. Costs of each approach were calculated. RESULTS: Doctors receiving the educational facilitator approach were significantly more likely than those receiving the other two approaches to have seen the kit, to rate the method of delivery as engendering motivation to try the kit, to have used one of the "intensive intervention" components from the kit, to report that they found the kit less complicated, and to report greater knowledge of how to use the kit. There were no significant differences in use of "minimal intervention" components of the kit, ratings of overall acceptability of delivery, perceptions of cultural and structural barriers to using the kit, and ratings of the overall acceptability of the kit. The cost of the educational facilitator approach ($A142/doctor) was 24 times that of the mailed approach. The volunteer courier approach ($A14) was twice the cost of the mailed approach. CONCLUSION: Educational facilitators and volunteer couriers do not seem to be cost effective strategies for distributing smoking interventions.

Adult↗
PubMed1992

Development and validation of the PCQ: a questionnaire to measure the psychological consequences of screening mammography.

We have developed a reliable and valid questionnaire to measure the psychological consequences of screening mammography. The questionnaire measures the effect of screening on an individual's functioning on emotional, social, and physical life domains. Content validity was ensured by extensive review of the relevant literature, discussion with professionals and interviews with attenders at a pilot Breast X-ray Screening Program in Melbourne, Australia. Discriminant validity was assessed by having expert judges sort items into dimensions which they appeared to be measuring. Acceptable levels of concordance (above 80%) with a priori classifications were found. Concurrent validity was demonstrated by comparison of subscale scores of 53 attenders at the Breast X-ray Program with an independent interview assessment of dysfunction on each of the emotional, social and physical dimensions. There was over 79% agreement between interview scores and questionnaire scores for each dimension. Construct validity was confirmed by showing that subscale scores varied in predicted ways. For women who were recalled for further investigation, scores on each subscale measuring negative consequences, were higher at the recall clinic than at screening clinic (emotional: t = -7.28; df = 70; P less than 0.001; physical: t = -2.53; df = 70; P = 0.014; social: t = -2.49; df = 70; P = 0.015). The internal consistency of all subscales was found to be acceptable. This questionnaire is potentially useful for assessing the psychological consequences of the screening process and should have wide application.

Female↗
PubMed1992

An analysis of reported discomfort caused by mammographic X-ray amongst attenders at an Australian pilot breast screening program.

The aims of the study were to describe levels of discomfort experienced by women undergoing screening mammography; examine correlates of discomfort experienced and to examine whether the degree of discomfort experienced was perceived as a deterrent for re-screening. The study involved ninety five attenders at the pilot mammography screening program in Melbourne, Victoria. Women completed a questionnaire one or two days after having a screening mammogram. Pain was assessed on a seven point scale. Information was obtained on a number of possible correlates such as breast tenderness, perceptions of the service received and expectations of discomfort. Eighty-eight women were re-interviewed three months later about recall of discomfort and whether this would deter them from future mammography. Results were as follows: Thirty per cent of women reported no discomfort, 60% mild or moderate discomfort and 10% severe discomfort or worse. The degree of discomfort reported was not significantly related to age, breast tenderness in the previous three days, previous symptoms, previous mammographic experience, or outcome of visit. The degree of discomfort was related to retrospectively reported expectation of discomfort (r = .336; p = .001); reported lack of confidence in the staff taking the X-ray (r = .184; p = .039); perceptions of awkwardness (r = .175; p = .049) and unpleasantness (r = .297; p = .002) of the examination position. No woman said discomfort would definitely stop her having another screening mammogram. Three per cent said that it might stop them, while 97% of women said that it would not stop them at all.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast↗
PubMed1992

Preferences of rural Victorian women for screening mammography services.

The aim of this study was to examine rural women's access to regional fixed-site screening mammography services and their preferences for either a mobile service or a fixed-site centre. One hundred and thirty-seven women aged 49 to 69 from rural Victoria were interviewed in June 1991. Eighty-five per cent of women normally go to major towns which are possible screening sites at least once every six months, spending an average of five hours each visit. Around 77% of women said they would be likely to go to a fixed site while 86% said they would be likely to go to a mobile service. If the fixed-site centre was at a major town not usually frequented, this would be a deterrent to 58% of women. A decision to widely implement mobile screening in rural areas of Victoria is not justified at this time, but pilot mobile services should be considered.

Aged↗
PubMed1992

Barriers to cervical screening in older women.

OBJECTIVE: To explore the reasons why some older women do not have regular Papanicolaou smear tests. SETTING: The Ballarat region of Victoria. DESIGN AND METHOD: Cross-sectional survey administered by telephone interview. SAMPLE: Three hundred and forty-seven women aged 40 to 70. RESULTS: 1. 41% of women had not had a Papanicolaou smear test within the preceding 2 years. 2. Women who agreed with the statement that healthy women do not need to have Papanicolaou tests were six times more likely to be overdue for a Papanicolaou test than women who did not agree. 3. Being over 60 significantly increased the likelihood that a woman would be overdue for a Papanicolaou test, compared with younger women. 4. Women who thought that the test is only needed at intervals of 3 years or more were over six times more likely to be overdue than women who believed the interval to be 2 years or less. 5. Women who perceived themselves as being too embarrassed were nearly seven times more likely to be overdue than women who claimed no embarrassment. 6. Women who saw themselves as being too busy to have the test were three times more likely to be overdue than women who did not see themselves this way. 7. Women with a spouse were less likely to be overdue than other women. 8. Women who knew to start having Papanicolaou tests when they were sexually active were less likely to be overdue than women who did not know this. CONCLUSION: Many of these barriers can be overcome by the clinician in routine practice.

Adult↗
PubMed1991

Cervical cancer screening: a comparison of recruitment strategies among older women.

OBJECTIVE: To compare the effectiveness of different recruitment strategies in encouraging older women to have a Papanicolaou (Pap) test. DESIGN: A 2 x 2 factorial study. SETTING: Two rural areas of Victoria, Australia. PARTICIPANTS: A total of 10,620 persons aged between 40 and 69 years and designated as female on electoral lists. INTERVENTIONS: A personal letter of invitation and a community-based campaign of 4 weeks' duration alone and in combination. A control group received no active intervention. OUTCOME MEASURE: The proportion of eligible women having a Pap test report issued by the Victorian Cytology Service during the 12 weeks after the intervention compared with the 12 weeks before the intervention, with an intervening two-week washout period. RESULTS: The odds ratio of an eligible woman being screened during the intervention period relative to the pre-intervention period was 3.00 for women who were exposed to the campaign and sent the letter of invitation (95% confidence interval, 2.38-3.77, P less than 0.001), 1.86 for women who were exposed to the campaign (95% confidence interval, 1.49-2.33, P less than 0.001), 1.61 for women who were sent the letter of invitation (95% confidence interval, 1.34-1.92, P less than 0.001). The baseline was a control group who received no active intervention. CONCLUSIONS: Both personal invitation letters and community-based campaigns are effective in recruiting women for Pap test screening. Combined strategies are more effective than single strategies.

Adult↗
PubMed1991

Development and validation of an instrument to measure satisfaction of participants at breast screening programmes.

A reliable and valid questionnaire has been developed to measure the satisfaction of participants with service offered at mammography screening programmes. The questionnaire measures five specific aspects: convenience and accessibility, staffs' interpersonal skills, information transfer between staff and client, physical surroundings and perceived technical competence of staff. A general satisfaction dimension was also included. Systematic procedures were followed to ensure that the initial pool of items met the criteria for satisfactory content validity. These procedures included extensive literature review and interviews with participants and service providers. Discriminant validity was assessed by a modified Q-sort procedure, where eight expert judges sorted items into relevant dimensions. The sample for other validity and reliability testing consisted of 584 women who were participants at a breast X-ray programme in Melbourne, Australia. Concurrent validity was demonstrated by considering the correlation of the sum of the subscale scores for each respondent with their score on the general subscale (r = 0.76; P less than 0.001). Multiple regression was used to provide further evidence for the discriminant validity of the proposed subscales and support for the multidimensional conceptualism of satisfaction. Scores on the general satisfaction subscale were used as an outcome variable and other subscale scores were predictor variables. All subscale scores significantly contributed to the prediction of satisfaction, over and above that of other subscales (R2 = 0.59). This indicates that these subscales are measuring distinct dimensions of satisfaction. Cronbach's alpha of each subscale was over 0.50, indicating that the subscales are reliable. The instrument is a potentially useful tool for assessing the quality of care at mammographic screening services and could be used routinely by such services to monitor satisfaction.

Australia↗
PubMed1991

The relative influence of intelligence and age on everyday memory.

A short memory test that provides analogs of everyday activities was used to investigate the relationship between everyday memory, cognitive abilities, participation in social, domestic, and leisure pursuits, and health status among 94 community-dwelling people aged between 70 and 93 years. Multiple regression analysis revealed that while fluid intelligence was a significant predictor of performance on most of the memory items, age was also a significant predictor of performance on prospective and verbal memory items, over and above the effects of intelligence. Crystallized intelligence and years of formal education showed little predictive power, but an index of participation in social and domestic activities was a good predictor of verbal, visual, and spatial memory items. It is concluded that cognitive decline in aging involves more than a simple decline in fluid intelligence.

Activities of Daily Living↗
PubMed1991

Development of a strategy to encourage attendance for screening mammography.

The present study describes a method for the data-driven structuring of interventions to increase participation in screening mammography. We interviewed 668 randomly selected women from the target population of an Australian pilot screening mammography program before this Program commenced. The aims of the study were to use cross-sectional data to determine factors which predicted women's intentions regarding attendance at the Program, and on the basis of these results to develop optimal strategies to encourage attendances. Of the sample, 64% said they intended to go to the Program, while 11% were unsure. A number of variables were significantly associated with intention and regression analysis was used to determine the best model for predicting intention. Ten variables entered the final regression model: the intensity of thought about getting breast cancer; a belief that early detection is extremely desirable and that screening mammograms are accurate; having had a Pap test within the last 2 years; a belief that health is controlled by chance; perceived ease of getting to the hospital; subjective familiarity with the hospital location of the Program; age; having heard about screening mammography; and a feeling of personal susceptibility to breast cancer. This model explained 20% of the variance in intention to have a mammogram (R 2 = 0.20, F(10,492) = 12.08; P less than 0.0001). The practical applications of these findings are discussed in this report. It is recommended that if a campaign were to concentrate on changing women's perceptions on the dimensions found to be significantly associated with intention, then it would have maximum chance of encouraging attendance amongst women in the target population. The strategies we have developed based on these findings are discussed in this paper.

Aged↗
PubMed1991

Cancer-related beliefs and behaviours in Australia.

A sample of 3527 adults aged 16 years and over was interviewed in their homes to obtain Australian data on selected behavioural risk factors for cancer. Four fifths of those interviewed nominated at least one step that individuals may take to reduce their risk of cancer, while 14 per cent believed there were no preventive measures available. Most salient among the preventive steps mentioned were 'not smoking' (58 per cent), dietary measures (30 per cent) and protection of the skin against the sun (13 per cent). Various psychological factors were mentioned by 7 per cent. Beliefs about dietary factors associated with cancer and the direction of the relationship tended to be accurate but there appeared to be some confusion with heart disease dietary risk factors. One third of respondents had at some time noticed a skin sign they thought might be cancer, and this was related (as expected) to latitude of residence. Nearly half had at some time systematically checked their skin for lesions, and 13 per cent said they had done this at least six times in the preceding year. Overall, 78 per cent of women respondents said they had been screened for cervical cancer, and 51 per cent said this had taken place in the past two years. Twelve per cent reported having had a mammogram, 7 per cent that were apparently diagnostic and 5 per cent that were reported to be routine screening mammograms. Overall, 78 per cent said they had done systematic breast self-examination at least once, including 41 per cent who said they had done breast self-examination in the past month and 23 per cent who reported having done it monthly over the previous year.

Adolescent↗
PubMed1991

Women's perceptions of screening mammography.

A random sample of women in Sydney were interviewed by telephone to determine their knowledge about and attitudes to mammography. A response rate of 56 per cent (628 women) was obtained. While the majority of women had had some experience with breast cancer, knowledge about which age groups were most at risk and treatment alternatives was limited. Only about half of the sample had heard about screening mammography before the survey. However, when a simple explanation was given, 79 per cent expressed a favourable attitude toward it. Only 22 per cent of women thought of themselves as being personally susceptible to breast cancer; the proportion was lower in women over 60 than in those in their 40s. Morbid concern about breast cancer was rare. About a quarter of the sample expressed concern about mammographically induced exposure to radiation. Attitudes and perceptions of personal susceptibility were not associated with knowledge about risks of breast cancer. However, having a favourable attitude and a lack of concern about radiation were associated with previously having heard about screening mammography. Women speaking a language other than English at home and from households where the main income earner was in an unskilled occupation were least likely to have heard of screening mammography. Suggestions for data-based recruitment strategies are discussed.

Attitude to Health↗
PubMed1990

Increasing cervical screening in women of more than 40 years of age: an intervention in general practice.

An intervention that was aimed at increasing cervical screening in women of more than 40 years of age was undertaken, with general practitioners as the primary point of contact. The intervention consisted of the practice receptionist giving female patients pamphlets about Papanicolaou smear-tests and the general practitioner offering a Papanicolaou smear-test. Nineteen general practitioners and their female patients (n = 466) of more than 40 years of age who presented for consultation over a 10-day period were involved in this study. Each woman in the study was asked when she had last undergone a Papanicolaou smear-test. All women who were found to be "at risk", that is, who had not undergone a Papanicolaou smear-test in the previous two years (57% of those women who were asked) were offered cervical screening. Over-all about 50% of the women who were found to be "at risk" underwent a Papanicolaou smear-test at the general practitioner initiated request, either at the same consultation (26% of those "at risk") or on their return at a later date (23% of those "at risk"). Therefore, the intervention appears to have been effective in encouraging a relatively high-risk group of patients to undergo Papanicolaou smear-tests. However, the strategy was differentially effective depending on age: more women of less than 65 years of age underwent a Papanicolaou smear-test than did women of more than 65 years of age. The feasibility of using the intervention in everyday general practice depends on the willingness of medical practitioners to ask female patients to undergo a Papanicolaou smear-test, the ability to take a Papanicolaou smear during the consultation or soon after, and the acceptance of the invitation by women as based on an understanding of the need.

Adult↗
PubMed1990

Assessing everyday memory in patients with dysphasia.

An assessment of the current memory status of patients referred for speech therapy is rarely provided, but may be useful in indicating whether there is memory loss in addition to language deficits. Failure to progress during treatment could be due to failure to remember the content of the previous sessions. Most existing memory tests are unsuitable for assessing subjects with dysphasia. For that reason we sought to modify the Rivermead Behavioural Memory Test (RBMT: Wilson, Cockburn & Baddeley, 1985), which was developed to measure the existence and extent of everyday memory problems and which contains both verbally and non-verbally mediated items. The study described here, based on a sample of 176 brain-injured patients, showed that a mild to moderate language deficit did impair performance on the RBMT. The influence was found to be limited to a subset of verbal memory items. A shortened version of the test was developed and shown to be sensitive to memory deficits and insensitive to the effects of dysphasia. Revised norms for this version of the test are provided. These should enable an estimate to be made of the presence and magnitude of memory deficits in dysphasic patients, allowing treatment to be optimized.

Adolescent↗
PubMed1989

Encouraging attendance at screening mammography: knowledge, attitudes and intentions of general practitioners.

We surveyed a random sample of 200 general practitioners from the Sydney metropolitan area about their attitudes to and knowledge of screening mammography. General practitioners' knowledge about some aspects of screening mammography was found to be limited; only 25% of the sample knew that the risk of breast cancer increases with age and only 30% of the sample knew that the evidence for a reduction in mortality as a result of mammographic screening is weakest for women of less than 50 years of age. Ninety-five per cent of general practitioners were of the opinion that breast self-examination and clinical examination were important for asymptomatic women of more than 45 years of age compared with the 75% of respondents who viewed mammography in the same way. Scores on a scale that was constructed to measure attitudes to mammographic screening showed that 20% of general practitioners had a "very favourable" attitude, and that a further 67% of general practitioners had a "favourable" attitude. No general practitioners had a "very unfavourable" attitude. Eighty-four per cent of general practitioners indicated that they would recommend that their patients attend a free screening-mammography service. Willingness to recommend mammographic screening was predicted by a general practitioner's attitude score. The strongest component of this prediction was a belief that the benefits of screening mammography outweighed the radiation risks. General practitioners need to be supplied with correct information about target groups for screening, so that women in the appropriate age-groups are encouraged to attend screening programmes.

Age Factors↗