University of Texas - Houston, Field Center

Background: Data from the qualitative and quantitative phases of this study showed that women across race/ethnicity strongly expressed a desire to be involved in medical decisions with their physicians. We have developed an intervention with written and video materials to improve minority women's communication skills with physicians and to increase women's involvement in medical decision making. The purpose of this pilot study is to compare the effect of the intervention given in two methods: self-study by individual women presenting for routine primary medical care; group session for women in naturally occurring social groups. We expect that the group approach will be more effective. However, we want to test the feasibility of individual administration because many women in health care settings are most easily reached at the time of routine medical care.

Description of intervention: A workbook entitled "The Decision is Yours: Working Together with Your Doctor" consists of 4 components: 1) a video designed to increase women's involvement in decision-making for benign uterine conditions; 2) a written section on patient-doctor communication skills using information, motivational techniques, role modeling, reinforcement and self-monitoring. This section also refers to examples from the video and includes a worksheet on preparing for an office visit; 3) a written section on medical decision making with emphasis on important steps to quality decision making. We use some of the same methods from the first section plus a decisional balance sheet for working through decisions. Examples of other women's decisional balance sheets are included; 4) a section with information culled from many sources on key issues of women's health such as - anatomy related to benign uterine conditions, menopause, hormone replacement therapy, preparing for surgery, sexuality, recommended screening tests, choosing a health plan, local resources for health information and internet access, how to evaluate health-oriented web sties. Women receiving the intervention as individuals will be approached at non-emergent clinic visits in the two community health centers. Recruitment, consent, and introduction to materials will be provided by female project staff members. A 15-minute one-on-one session will present the materials, will enourage them to watch the video and will show the two booklets. Arrangements for follow-up will also be included. Women receiving the intervention in groups will attend a 1 1/2-2 hour group session lead by a community lay health volunteers trained by our staff. Groups will be recruited from community centers, church organizations, parent-teacher groups, and apartment complexes.

Methods: The target population is adult women over age 30 residing in 2 Houston communities. We have specified three subgroups of women: African-Americans, English speaking Hispanics, and Spanish speaking Hispanics. The total sample size for this pilot is 180 women divided among the 3 groups. Numbers of participants in each category are shown below:
 

Race/ethnicity	Method
	Group (n=90)	Individual (n=90)
African-American	60	30
Hispanic, English-speaking	30	15
Hispanic, Spanish-speaking	30	15

Women receiving the intervention as individuals will be approached at non-emergent clinic visits in the 2 community health centers. Recruitment, consent, and introduction to materials will be provided by female project staff members. The 1 1/2 - 2 hour group session will be led by community lay health volunteers trained by our staff. Groups will be recruited from community centers, church organizations, parent-teacher groups, and apartment complexes.

Participants will be asked to complete pre and post-intervention surveys regarding their beliefs, attitudes, and self-efficacy in the areas of communication and decision making. The post test questionnaire will be administered by project staff over the phone and will include evaluation of the workbook, video, and group leaders (if appropriate) as well as suggestions for improvement and dissemination.