. 2006 Aug;13(4):130–140.

TABLE I.

Strategy for dissemination of cancer control interventions in adult healthy diet

Reference^a
Albright et al., 1992 ¹²
Purpose: Test a dissemination model for providing clinical preventive medicine (cpm) training to internal medicine faculty across the country
Study design: Cohort, one group, pre/post (n=10)
Internists were trained as trainers; 91 faculty members attended home-site seminars led by trainers
Target group: General internal medicine faculty
Quality assessment: Weak
Strategy evaluated: Train-the-trainer (month-long training, off site)
Interventions:cpm curriculum encompassed: smoking cessation, clinical nutrition, weight control exercise, hyperlipidemia, and national screening guidelines
Curriculum provided content on clinical teaching and medical decision-making
Clinical nutrition section included interventions that promoted healthy diets in adults
Findings: Fidelity ratings obtained from videotapes of the home-site seminars given by the trainers indicated that the trainers adhered closely to the cpm
Trainers teaching home-site internal medicine faculty: knowledge of smoking cessation, cholesterol, and screening-specific information of faculty members significantly increased post-seminar in the last 2 of the 3 years studied (p<0.02 and p<0.001)
Faculty’s ratings of their self-efficacy to implement the cpm practices for clinical nutrition demonstrated significant post-test increases for all 3 years (p<0.0001)
Faculty use of specific behaviour-change interventions (diaries, self-help materials, and social support) to promote healthy diet increased (p<0.05)
85% of the faculty in 1986, 96% in 1987, and 84% in 1988 reported teaching the cpm strategies to their house staff
House staff reported significant increases in the degree to which the faculty addressed cpm in their teaching interactions (1987: p<0.0001; 1988: p<0.04)
House staff ratings of their self-efficacy to implement specific preventive medicine strategies increased in both years (1987: p<0.0001; 1988: p<0.002)
Anderson et al., 1989 ¹⁵
Purpose: Examine inquiries received by the cis, a telephone hotline, to determine:
(1) effects of different media in stimulating calls to the cis
(2) demographic characteristics of callers in four cancer prevention and early detection subjects: smoking, nutrition, Pap smear screening, and breast self-examination
Study design: Descriptive study
Retrospective analysis of 5 years of inquiries to 1 national and 26 local cis offices in four subject areas; a standardized call record form was completed for each call
Demographic information was collected only during the last 2 years of the study for first-time, non-health professional callers and was limited by federal stipulations to 20% of callers in five cis offices (n=57,374) nutrition-related calls over the 5 years studied
Target group: Smokers in the United States, Mexico, and other countries
Quality assessment: Weak
Strategy evaluated: Multiple media sources (television, radio, newspapers)
Interventions:cis, a telephone-based information and education program of the National Cancer Institute
Findings: Sources of callers’ learning about the cis hotline were television 33.9%, radio 28.2%, publications (including newspapers, magazines, pamphlets, and posters) 26.9%, health care providers 4.3%, significant others 4.6%, and telephone assistance 2.2%
Television was the most common information source reported by callers for both sexes (72.2% of male callers and 60.7% of female callers)
An inverse relationship was found between frequency of television cited as an information source and the age and education of callers. In the 19-year-old or younger age group 81.7% of callers cited television, as compared with 39.6% of callers in the 60-year-old or older age group
Television was the predominant source for four of the five ethnic groups (Caucasians, African Americans, Hispanics, and Native Americans). For callers of Asian or Pacific Island heritage, the most frequently cited source was publications (46.7%), followed by television (32.1%).
Buller et al., 1999 ⁹
Purpose: Test a peer-education strategy to promote the 5-A-Day message
Related papers: Buller et al., 2000 ¹⁰ (reported below) and Larkey et al., 1999 ¹¹ (reported below)
Study design: Randomized controlled trial
Experimental group (n=505) employees (in 46 cliques) assigned to receive 5-A-Day peer-education, plus the general 5-A-Day program
Control group (n=492) employees (in 46 cliques) assigned to receive the general 5-A-Day program (cafeteria promotions and workplace mail) only
Target group: Anglo and Hispanic worksite population in the United States (lower socioeconomic labour and trade employees)
Quality assessment: Weak
Strategy evaluated: Peer educators (n=42)—chosen for “centrality,” rated highest by peers in communication ties and flow—attended a 16-hour training program; trained in persuasive communication techniques
Expectation was that they would spend 2 hours weekly discussing fruit and vegetable intake with coworkers
Interventions: 5-A-Day message plus accompanying 5-A-Day printed materials
Findings: Immediate changes post-intervention in awareness, attitudes, and dietary behaviour:
Employees receiving peer education increased their awareness of the 5-A-Day program (p<0.001) and their knowledge of the 5-A-Day concept, attitudes toward fruit and vegetable intake (p=0.024–<0.001)
Number of daily servings of fruits and vegetables consumed increased (0.77 on 24-hour intake recall, p<0.001, and 0.46 on food frequency questionnaire items, p=0.002)
Persistence of changes in awareness, attitudes, and dietary behaviour (6-month follow-up):
General persistence of the statistically significant increases in the peer-education group, but of reduced magnitude for knowledge of the 5-A-Day program and diet-related attitudes
Statistically significant increases total number of daily servings persisted when measured by 24-hour intake recall (0.41, p=0.034), but not by food frequency questionnaire
Buller et al., 2000 ¹⁰
Related papers: Buller et al., 1999 ⁹ (reported above) and Larkey et al., 1999 ¹¹ (reported below)
Study design, Target group, Quality assessment, Strategy evaluated, Interventions: Same study as above
Findings: Findings pertain only to the peer-education (experimental group):
57% of employees reported printed materials stimulated discussion of fruits and vegetables with co-workers during program, 31% still discussing 6 months later, 69% discussed printed material with a family member during intervention
Greater contact with peer educators was related to larger immediate increases in total consumption of fruits and vegetables (p=0.003) as measured by food frequency items
When food types were examined separately, peer-educator contact was positively related to immediate increased vegetable intake (p=0.002), but not to fruit or juice intake
The more employees reported reading the printed material, the smaller the observed immediate increase in fruit consumption (p=0.002)
There was no significant association between peer contact and changes in total intake of these foods at the 6-month follow-up
Dietrich et al., 1992 ¹⁶
Purpose: Test the impact of physician education and facilitator assisted office-system interventions on cancer early detection and preventive services
Study design: Randomized controlled trial
98 of the 102 practices that agreed to participate completed the study
Unit of randomization was the practice as represented by one physician
Four groups:
Facilitator only (n=24 practices)
Workshop-plus-facilitator (n=26 practices)
Workshop only (n=24 practices)
Control (n=24 practices)
Target group: Office-based general practitioners and general internists in New Hampshire and Vermont
Quality assessment: Weak
Strategy evaluated:
(1) Facilitators visited each practice 3–4 times over 3 months for approximately 120 minutes each time Performed an initial audit of each practice to assess the status of preventive care and assisted practices in the design and implementation of office system interventions; practices only implemented those interventions that meet their perceived needs
(2) Facilitator-plus-workshop was the same as (1) plus physician from each practice attended a 1-day workshop led by an expert who reviewed nci’s prevention and screening recommendations and taught specific skills; also provided a written syllabus
Note: The workshop-only and the control groups did not receive information on the use of office-systems interventions for cancer prevention or early detection
Interventions: Multiple office-system interventions including preventive-care flow sheets, chart stickers, health education posters and brochures, and patient health diaries (none of the interventions were computer-based)
Findings: Response rate for the cross-sectional survey was 91% (n=2436 patients) pre-experiment and 93% (n=2595) at 12-month follow-up
More eligible patients in the facilitator-only group reported their physician had advised them to reduce fat intake compared to patients in the control group at 12-month follow-up (proportion: 0.56 vs. 0.47, p<0.05; baseline results were used as covariates)
No significant increase in the number of eligible patients in the facilitator-plus-workshop group reporting their physician had advised them to reduce fat intake compared with patients in the control group at 12-month follow-up (proportion: 0.51 vs. 0.47)
No significant increase in the number of eligible patients in the facilitator-only or facilitator-plus-workshop groups reporting their physician had advised them to increase fibre consumption compared to patients in the control group at 12-month follow-up (proportion: 0.48 facilitator-only vs. 0.38 control; 0.41 facilitator-plus-workshop vs. 0.38 control)
Overall conclusion: Community practices assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services
Larkey et al., 1999 ¹¹
Purpose: Assess which persuasive strategies are used by peer health educators, which strategies are used more in one-on-one vs. group contexts, and which strategies are most likely to be used by males and by females
Related papers: Buller et al., 2000 ¹⁰ (same project, see additional findings above) and Buller et al., 1999 ⁹ (same project, see additional findings above)
Study design: Qualitative, descriptive study of peer-educator within original randomized trial
Target group: Anglo and Hispanic worksite population in the United States
Quality assessment: Weak
Strategy evaluated: Peer-educators (n=42) chosen for “centrality,” rated highest by peers in communication ties and flow
Interventions: 5-A-Day message (to increase fruit and vegetable intake) plus accompanying 5-A-Day printed materials
Findings: Peer health educators were more likely to use “role modeling” (p=0.0004) and “creating context” (p<0.0001) as group change strategies, and “encouragement” (p=0.0009) and “responding to employee needs” (p=0.0001) were more likely to be used as individual change strategies
Strategies used differed with the sex of the educator; “mock competition,” “giving materials,” and “encouragement” were used by men significantly more than “creating context” and “keeping 5-A-Day visible”; women used “creating context” and “keeping 5-A-Day visible” significantly more than “mock competition”, “giving materials” and “encouragement” (p<0.0001 for all contrasts)
Hispanic peer health educators were more likely to use individual change strategies than their non-Hispanic counterparts (p=0.0128)
Patterson et al., 1998 ¹⁴
Purpose: Test whether the Working Well Trial nutrition intervention activities were maintained after the research program or were adopted by control sites
Related papers: Sorensen et al., 1998 ²²
Study design: Randomized controlled trial
Dissemination of work-site smoking cessation interventions from the Working Well Trial to control cited at the end of the trial (n=54 control sites)
Target group: Worksite management
Quality assessment: Moderate
Strategy evaluated: Intervention materials were given to control sites (method not specified) at the conclusion of the Working Well Trial
Interventions: Nutrition interventions from the Working Well Trial
Findings: Only the findings pertaining to the control sites at the conclusion of the Working Well Trial are reported in this table
There was a significant increase in nutrition activity score (composite of nutrition classes or weight loss programs; self-help nutrition manuals and guides; videotapes, posters or brochures related to nutrition) from baseline to the end of the Working Well trial (2-year interval between start and completion of the trial; p=0.0012)
There was no significant increase on nutrition activity score in the control sites, between the end of the Working Well trial (point of dissemination of the nutrition interventions to control sites) and at the follow-up survey conducted 2 years
At follow-up, there was no significant difference between nutrition activity scores in the intervention compared with the control work sites
Samuels et al., 1993 ¹³
Purpose: Report on the first 3 years of the Project lean campaign, a national social marketing intervention, designed to promote dietary change
Study design: One group, post-intervention, process evaluation
Target group: General adult population
Quality assessment: Weak
Strategy evaluated: Media awareness campaign (television and print media)
Interventions: Telephone hotline which provided advice and offered an information booklet to callers
Findings: As a result of the ads and campaign publicity, the hotline received nearly 300,000 consumer calls
During the first 12 months of the campaign, calls peaked at 25,000–28,000 monthly; as publicity declined, so did calls to the hotline
Hotline was terminated after 18 months because of expense (more than US$300,000 annually)
Tziraki et al., 2000 ¹⁷
Purpose: Determine the effectiveness of two strategies for promoting the use of an nci nutrition manual by primary care physicians and their office staff
Study design: Randomized controlled trial
810 practices were randomized; 55 practices had a change in status and became ineligible after randomization
Workshop group (n=244): Practices received the manual and were invited to a training workshop
Postal delivery group (n=256): Practices were mailed the manual
Control group (n=255): Practices did not receive the manual
Target group: Free-standing primary care practices in Pennsylvania and New Jersey
Quality assessment: Weak
Strategy evaluated:
(1) Workshop: One staff member from each practice was invited to attend a 3-hour training session. Training was provided in the four major components of the manual—how to organize the office environment, how to screen patient adherence, how to provide dietary advice, and how to implement a patient follow-up system
(2) Postal delivery of the manual only (no training)
Interventions:nci sponsor nutrition manual for cancer prevention (contains multiple interventions)
Modelled after the nci publication How to Help Your Patients Stop Smoking
The manual addressed brief counselling techniques, office system organization, material resources, staff training, and patient educational materials
Findings: Follow-up interviews and observational assessments were conducted at 4–6 months post-dissemination with a physician and staff member from each practice
Adherence scores were calculated for four areas: office organization, nutrition screening, nutrition advice or referral, and patient follow-up
<50% of practices assigned to the workshop group sent representatives to the training workshop (120 of 244)
Workshop group was significantly more adherent to the manual’s recommendations for office organization at follow-up than the postal-delivery group (28.5% vs. 24.7%, p<0.005) and control group (28.5% vs. 23.0%, p<0.001); these analyses included all practices in the workshop group regardless of attendance at the training session.
Of those practices who attended the workshop, 30.6% were adherent to the recommendations for office organization
Workshop group was significantly more adherent to the manual’s recommendations for nutrition screening at follow-up than the postal-delivery group (23.5% vs. 21%, p<0.05) and control group (23.5% vs. 20.5%, p<0.05)
Of those practices attending the workshop, 25% were adherent to the recommendations for nutrition screening
No significant difference between the postal-delivery and control groups for office organization (24.7% vs. 23.0%) or nutrition screening (21% vs. 20.5%)
No statistically significant difference between the three groups for nutrition advice (workshop 54.9%; postal-delivery 53%; control 52.3%) nor for patient follow-up (workshop 14.6%; postal-delivery 13.6%; control 13.6%).
The attending workshop practices were significantly more likely than either postal-delivery (57% vs. 53%, p<0.05) or control groups (57% vs. 52.3%, p<0.05) to provide nutrition screening

All located papers from U.S. sources.