DESCRIPTION (provided by applicant): This is an exploratory behavioral research project, which focuses on the development of an effective outreach intervention for mammogram-resistant women. In our previous cancer control work, we identified a group of women who were not up to date with mammogram screening recommendations. This group was identified by their intentions: not planning to get a mammogram. The importance of this finding is twofold. 1) This is a mammoqram-resistant group. These women have not responded to a public health climate of mammography recommendations, a strong reminder system (annual written reminders from their managed care organization and quarterly reports of their overdue status to their primary care physicians), or tailored telephone counseling. 2) These women are an at risk population. They are at risk for the development of advanced breast cancer, which is more lethal than cancers discovered by screening. At least 15 percent of women may be mammogram resistant. Because tailored telephone counseling is a cost-effective intervention and is easily integrated into health care systems, we wanted to explore whether enhancing the intervention would make it effective with mammogram-resistant women. In order to develop a meaningful improvement in tailored telephone counseling, we need to know more about this group. Our study begins with in-depth qualitative research, designed to understand the reluctance, psychosocial characteristics and global feelings/beliefs about breast cancer and breast cancer screening. We will then develop an enhanced telephone-based counseling intervention. New strategies include: motivational interviewing, a technique developed to motivate classically resistant patients (alcoholics and tobacco/drug addicts); multiple calls; supplementary materials; and an effort to improve access and physician recommendation. This will be pre-tested on mammogram-resistant women and adjusted following evaluation of their responses and input. The enhanced intervention will then be pilot tested on 50 mammogram-resistant women and evaluated for its success in moving them towards mammography. Outcome measures include rate of mammography utilization by radiology billing records and by self-report. Secondary measures include changes in stage and other variables. The project is grounded in two strong behavioral theories: The Precaution Adoption Process Model of Weinstein and the Cognitive-Social Information Processing (C-SHIP) Model of Miller and Shoda. This study should increase scientific knowledge about an at-risk population and the limits of telephone based counseling. If successful, the enhanced intervention would be tested in a randomized controlled trial and could be modified to include groups resistant to other screenings (e.g. pap smear or colon cancer screening). If not successful, one could avoid using telephone-counseling strategies in this resistant group. Alternative avenues of communication and motivation would need to be developed.