Intervention Mediators in a Randomized Controlled Trial to Increase Colonoscopy Uptake Among Individuals at Increased Risk of Familial Colorectal Cancer

Barbara H. Brumbach, Wendy C. Birmingham, Watcharaporn Boonyasiriwat, Scott Walters, Anita Y. Kinney

Research output: Contribution to journalArticle

2 Scopus citations


Background: Understanding the pathways by which interventions achieve behavioral change is important for optimizing intervention strategies. Purpose: We examined mediators of behavior change in a tailored-risk communication intervention that increased guideline-based colorectal cancer screening among individuals at increased familial risk. Methods: Participants at increased familial risk for colorectal cancer (N = 481) were randomized to one of two arms: (1) a remote, tailored-risk communication intervention (Tele-Cancer Risk Assessment and Evaluation (TeleCARE)) or (2) a mailed educational brochure intervention. Results: Structural equation modeling showed that participants in TeleCARE were more likely to get a colonoscopy. The effect was partially mediated through perceived threat (β = 0.12, p < 0.05), efficacy beliefs (β = 0.12, p < 0.05), emotions (β = 0.22, p < 0.001), and behavioral intentions (β = 0.24, p < 0.001). Model fit was very good: comparative fit index = 0.95, root-mean-square error of approximation = 0.05, and standardized root-mean-square residual = 0.08. Conclusion: Evaluating mediating variables between an intervention (TeleCARE) and a primary outcome (colonoscopy) contributes to our understanding of underlying mechanisms that lead to health behavior change, thus leading to better informed and designed future interventions. Trial Registration Number:, NCT01274143.

Original languageEnglish
Pages (from-to)694-706
Number of pages13
JournalAnnals of Behavioral Medicine
Issue number5
StatePublished - 1 Oct 2017



  • Colonoscopy
  • Colorectal cancer screening
  • Extended parallel process model
  • Implementation-intention strategies
  • Structural equation modeling

Cite this