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Dec 2011

Tailored and Targeted Interventions to Encourage Dilated Fundus Examinations in Older African Americans

Author Affiliations

Author Affiliations: Departments of Ophthalmology and Visual Sciences (Dr Ellish) and Epidemiology and Public Health (Dr Royak-Schaler), University of Maryland School of Medicine, Baltimore; and Health Sciences, Howard University, Washington, DC (Dr Higginbotham). Dr Ellish is now with the Department of Epidemiology and Public Health, University of Maryland School of Medicine.


Arch Ophthalmol. 2011;129(12):1592-1598. doi:10.1001/archophthalmol.2011.190

Objectives To compare the effects of a tailored (individualized) and targeted (designed for a subgroup) print intervention in promoting dilated fundus examinations (DFEs) in older African Americans and to determine whether other factors (eg, demographics, preventive health practices, health literacy score, behavioral intentions, and DFE rates) are associated with getting a DFE.

Methods African Americans aged 65 years or older who had not had a DFE in at least 2 years were recruited from community settings. Participants were randomized to receive either a tailored or targeted newsletter. Telephone follow-up was conducted at 1, 3, and 6 months to ascertain eye examination status. All participant-reported DFEs were confirmed by contacting their eye doctor (optometrist or ophthalmologist) by telephone.

Main Outcome Measure Eye doctor–confirmed DFE at 6 months.

Results Of the 329 participants enrolled, 128 (38.9%) had an eye doctor–confirmed DFE. No significant difference was noted in this measure by intervention group (relative risk, 1.07; 95% confidence interval, 0.82-1.40), with 66 participants in the tailored group (40.2%) and 62 participants in the targeted group (37.6%) having an eye doctor–confirmed DFE. Based on logistic regression analysis, reading the newsletter (odds ratio, 1.76; 95% confidence interval, 1.08-2.87) and planning to make an appointment for a DFE (odds ratio, 2.46; 95% confidence interval, 1.42-4.26) were significant predictors for DFE.

Conclusions The tailored and targeted interventions were equally effective in promoting eye doctor–confirmed DFEs at 6 months. Given the increased cost and effort associated with tailoring, our results suggest that well-designed targeted print messages can motivate older African Americans to get DFEs.

Trial Registration clinicaltrials.gov Identifier: NCT00649766