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Barakat LP, Stevens E, Li Y, Reilly A, Deatrick JA, Goldstein NE, Schwartz LA. Evaluation of the Pediatric Research Participation Questionnaire for Measuring Attitudes Toward Cancer Clinical Trials Among Adolescents and Young Adults. J Adolesc Young Adult Oncol 2019; 8:423-433. [PMID: 31025898 PMCID: PMC8666797 DOI: 10.1089/jayao.2018.0144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Reasons for the relatively low rates of adolescent and young adults (AYA) enrollment in cancer clinical trials in the United States require further empirical examination. In addition to structural factors such as lack of access and insurance barriers, attitudes toward clinical trials may be important to consider. This study aimed to evaluate and validate the Pediatric Research Participation Questionnaire (PRPQ)-a measure of attitudes to clinical trials adapted for AYA (15-29) with cancer and their caregivers. Methods: One hundred twenty-four AYA and 94 caregivers completed the PRPQ-AYA and measures of clinical trial knowledge and developmental/emotional maturity. Factor analysis evaluated the PRPQ-AYA structure, interitem reliability was computed, and Pearson correlations examined associations of validation measures with factor scores and computed scores reflecting perceived barriers, perceived benefits, and decision balance. Results: Confirmatory factor analysis did not confirm the prior PRPQ factor structure. Exploratory factor analysis suggested a new four-factor structure for: AYA (1) trust/mistrust, (2) barriers/costs, (3) support for participation, and (4) incentives; and caregivers (1) trust/access, (2) mistrust/costs, (3) support for participation, and (4) risks to AYA. Factor scores and barriers, benefits, and decision balance scores demonstrated acceptable interitem reliability and were significantly correlated with clinical trial knowledge and emotional maturity in the expected direction. Conclusion: PRPQ-AYA factor structure for AYA and caregivers varied and should be interpreted cautiously due to limited power. Simple solutions of perceived benefits, perceived barriers, and decision balance were reliable and valid and provide important information to address and engage AYA through the clinical trial informed consent process.
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Affiliation(s)
- Lamia P. Barakat
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Evelyn Stevens
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yimei Li
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Anne Reilly
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Janet A. Deatrick
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | | | - Lisa A. Schwartz
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Kim K, Xue QL, Walton-Moss B, Nolan MT, Han HR. Decisional balance and self-efficacy mediate the association among provider advice, health literacy and cervical cancer screening. Eur J Oncol Nurs 2017; 32:55-62. [PMID: 29353633 DOI: 10.1016/j.ejon.2017.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Health literacy has emerged as a potential determinant of cancer screening, yet limited literature has investigated the pathways which health literacy influences Pap tests among immigrant women who experience a higher incidence of cervical cancer. This study aimed to test a health literacy-focused sociocognitive model which proposes motivational (knowledge, decisional balance) and volitional (self-efficacy) factors mediating the association between health literacy and triennial Pap tests. METHODS Using structural equation modeling, we conducted a secondary analysis of baseline data obtained from a randomized controlled trial to promote breast and cervical cancer screenings among 560 Korean American women 21-65 years of age. They were interviewed on demographics such as education and English proficiency, provider advice, health literacy, knowledge of cervical cancer, decisional balance for Pap tests, self-efficacy, and Pap test use. RESULTS Higher health literacy predicted high level of knowledge and high decisional balance score, and greater self-efficacy and then only decisional balance and self-efficacy affected Pap tests. High level of knowledge predicted Pap tests through its impact on the decisional balance score. Receiving provider advice both directly and indirectly predicted Pap tests through high level of health literacy, high level of decisional balance and greater self-efficacy. CONCLUSIONS Findings from this study suggest possible pathways through which provider advice and health literacy affect Pap tests. Interventions targeting immigrant women with limited English proficiency should consider skill-based approaches such as health literacy training, promoting patient-provider communications and emphasizing decisional balance and self-efficacy as potentially sustainable ways of promoting Pap tests.
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Affiliation(s)
- Kyounghae Kim
- Department of Community-Public Health, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, USA.
| | - Qian-Li Xue
- School of Medicine, Johns Hopkins University, 733 N Broadway, Baltimore, MD 21205, USA
| | - Benita Walton-Moss
- Department of Nursing, School of Social Work, University of Southern California, 1150 South Olive St. Suite T1100, Los Angeles, CA 90015, USA
| | - Marie T Nolan
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, USA
| | - Hae-Ra Han
- Department of Community-Public Health, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, USA
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3
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Han HR, Song Y, Kim M, Hedlin HK, Kim K, Ben Lee H, Roter D. Breast and Cervical Cancer Screening Literacy Among Korean American Women: A Community Health Worker-Led Intervention. Am J Public Health 2016; 107:159-165. [PMID: 27854539 DOI: 10.2105/ajph.2016.303522] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To test a community health worker (CHW)-led health literacy intervention on mammogram and Papanicolaou test screening among Korean American women. METHODS We conducted a cluster-randomized trial at 23 ethnic churches in the Baltimore, Maryland-Washington, DC, metropolitan area between 2010 and 2014. Trained CHWs enrolled 560 women. The intervention group received an individually tailored cancer-screening brochure followed by CHW-led health literacy training and monthly telephone counseling with navigation assistance. Study outcomes included receipt of an age-appropriate cancer screening test, health literacy, cancer knowledge, and perceptions about cancer screening at 6 months. RESULTS The odds of having received a mammogram were 18.5 (95% confidence interval [CI] = 9.2, 37.4) times higher in the intervention than in the control group, adjusting for covariates. The odds of receiving a Papanicolaou test were 13.3 (95% CI = 7.9, 22.3) times higher; the odds of receiving both tests were 17.4 (95% CI = 7.5, 40.3) times higher. Intervention effects also included increases in health literacy and positive perceptions about cancer screening. CONCLUSIONS A health literacy-focused CHW intervention successfully promoted cancer-screening behaviors and related cognitive and attitudinal outcomes in Korean American women.
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Affiliation(s)
- Hae-Ra Han
- Hae-Ra Han and Kyounghae Kim are with the School of Nursing, Johns Hopkins University, Baltimore, MD. Youngshin Song is with the College of Nursing, Choongnam University, Choongchung-Do, Korea. Miyong Kim is with the School of Nursing, University of Texas, Austin. Haley K. Hedlin is with the Department of Medicine, Stanford University, Stanford, CA. Hochang Ben Lee is with the School of Medicine, Yale University, New Haven, CT. Debra Roter is with the Bloomberg School of Public Health, Johns Hopkins University
| | - Youngshin Song
- Hae-Ra Han and Kyounghae Kim are with the School of Nursing, Johns Hopkins University, Baltimore, MD. Youngshin Song is with the College of Nursing, Choongnam University, Choongchung-Do, Korea. Miyong Kim is with the School of Nursing, University of Texas, Austin. Haley K. Hedlin is with the Department of Medicine, Stanford University, Stanford, CA. Hochang Ben Lee is with the School of Medicine, Yale University, New Haven, CT. Debra Roter is with the Bloomberg School of Public Health, Johns Hopkins University
| | - Miyong Kim
- Hae-Ra Han and Kyounghae Kim are with the School of Nursing, Johns Hopkins University, Baltimore, MD. Youngshin Song is with the College of Nursing, Choongnam University, Choongchung-Do, Korea. Miyong Kim is with the School of Nursing, University of Texas, Austin. Haley K. Hedlin is with the Department of Medicine, Stanford University, Stanford, CA. Hochang Ben Lee is with the School of Medicine, Yale University, New Haven, CT. Debra Roter is with the Bloomberg School of Public Health, Johns Hopkins University
| | - Haley K Hedlin
- Hae-Ra Han and Kyounghae Kim are with the School of Nursing, Johns Hopkins University, Baltimore, MD. Youngshin Song is with the College of Nursing, Choongnam University, Choongchung-Do, Korea. Miyong Kim is with the School of Nursing, University of Texas, Austin. Haley K. Hedlin is with the Department of Medicine, Stanford University, Stanford, CA. Hochang Ben Lee is with the School of Medicine, Yale University, New Haven, CT. Debra Roter is with the Bloomberg School of Public Health, Johns Hopkins University
| | - Kyounghae Kim
- Hae-Ra Han and Kyounghae Kim are with the School of Nursing, Johns Hopkins University, Baltimore, MD. Youngshin Song is with the College of Nursing, Choongnam University, Choongchung-Do, Korea. Miyong Kim is with the School of Nursing, University of Texas, Austin. Haley K. Hedlin is with the Department of Medicine, Stanford University, Stanford, CA. Hochang Ben Lee is with the School of Medicine, Yale University, New Haven, CT. Debra Roter is with the Bloomberg School of Public Health, Johns Hopkins University
| | - Hochang Ben Lee
- Hae-Ra Han and Kyounghae Kim are with the School of Nursing, Johns Hopkins University, Baltimore, MD. Youngshin Song is with the College of Nursing, Choongnam University, Choongchung-Do, Korea. Miyong Kim is with the School of Nursing, University of Texas, Austin. Haley K. Hedlin is with the Department of Medicine, Stanford University, Stanford, CA. Hochang Ben Lee is with the School of Medicine, Yale University, New Haven, CT. Debra Roter is with the Bloomberg School of Public Health, Johns Hopkins University
| | - Debra Roter
- Hae-Ra Han and Kyounghae Kim are with the School of Nursing, Johns Hopkins University, Baltimore, MD. Youngshin Song is with the College of Nursing, Choongnam University, Choongchung-Do, Korea. Miyong Kim is with the School of Nursing, University of Texas, Austin. Haley K. Hedlin is with the Department of Medicine, Stanford University, Stanford, CA. Hochang Ben Lee is with the School of Medicine, Yale University, New Haven, CT. Debra Roter is with the Bloomberg School of Public Health, Johns Hopkins University
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Manne S, Steinberg MB, Delnevo C, Ulpe R, Sorice K. Colorectal Cancer Screening Among Foreign-born South Asians in the Metropolitan New York/New Jersey Region. J Community Health 2016; 40:1075-83. [PMID: 26072261 DOI: 10.1007/s10900-015-0053-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The goal of this study was to examine colorectal cancer (CRC) screening practices and factors associated with CRC screening among foreign-born South Asians living in the metropolitan New York-New Jersey area. Two hundred and eight men and women recruited from community settings in the New York and New Jersey metropolitan area completed a questionnaire that included demographics, CRC screening practices, health care access and practices, attitudes about the health care system, primary care physician support for CRC screening, cultural factors, and attitudes about CRC screening and CRC worry. Almost a third of the sample had not heard of any of CRC screening tests. Approximately 62 % of the sample had never had a CRC screening test and approximately 69 % of the sample was not currently on schedule with regard to CRC screening. When the relative contribution of significant correlates were evaluated, participants who had lived in the US for a longer time, who endorsed more CRC screening benefits, and who endorsed fewer CRC screening barriers were significantly more likely to have had CRC screening in the past. Participants who were more likely to use English in their daily life, who endorsed more CRC screening benefits, and endorsed fewer CRC screening barriers were more likely to be on schedule with regard to CRC screening. In conclusion, awareness of CRC screening and uptake of screening was low in this population of foreign-born South Asians. Interventions to promote CRC screening may benefit from targeting this subgroup of Asian Americans.
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Affiliation(s)
- Sharon Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
| | | | - Cristine Delnevo
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Rajiv Ulpe
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
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Abstract
The purpose of this study was to identify the stages and processes of change related to smoking cessation among vocational technical high school students to provide baseline data for smoking cessation programs. Cross-sectional data were collected in April and May, 2004, from 300 male students at three vocational technical high schools in Korean metropolitan areas. The survey instruments included: decisional balance; self-efficacy; nicotine dependence; stages and processes of change; and knowledge related to smoking. The results indicated that 31.7%, 39.2%, and 29.1% of current smokers were in the precontemplation, contemplation, and preparation stages, respectively, and that 42.6% and 57.4% of former smokers were in the action and maintenance stages, respectively. Decisional balance, self-efficacy, and nicotine dependence were significantly associated with the stages of change. Regarding the processes of change, only behavioral processes were significantly associated with the stages of change, with experiential processes showing no significant relationship. The study results suggest that smoking cessation programs should emphasize behavioral strategies to help students progress through the stages.
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Affiliation(s)
- Ok Kyung Ham
- Inha University, 253 Yonghyun-dong, Nam-gu, Incheon, Republic of Korea.
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Palmer RC, Fernandez ME, Tortolero-Luna G, Gonzales A, Mullen PD. Correlates of Mammography Screening Among Hispanic Women Living in Lower Rio Grande Valley Farmworker Communities. HEALTH EDUCATION & BEHAVIOR 2016; 32:488-503. [PMID: 16009746 DOI: 10.1177/1090198105276213] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Factors contributing to the underuse of mammography screening by female Hispanic farmworkers aged 50 years and older in the Lower Rio Grande Valley were determined through home-based, Spanish-language personal interviews ( N = 200). Questions covered adherence to screening mammography guidelines (mammogram within 2 years), healthcare access, sociodemographic characteristics, and theoretical constructs related to breast cancer screening in the literature. Multivariate findings indicated that adherent women were 3.6 times more likely to have health insurance. Self-efficacy for obtaining a mammogram and decisional balance were also significantly related to adherence; age, income, and education variables were not associated, perhaps because of restricted variation. Results indicate continuing efforts are needed to ensure that medically underserved migrant farmworker women have access to health care services. In addition, efforts to increase their self-efficacy in obtaining a mammogram and to counter negative attitudes and opinions by stressing the positive prognosis associated with early detection are warranted.
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Affiliation(s)
- Richard C Palmer
- University of Texas--Houston, School of Public Health, 77030, USA
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7
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Senore C, Ederle A, DePretis G, Magnani C, Canuti D, Deandrea S, Zorzi M, Barca A, Bestagini P, Faitini K, Bisanti L, Casale C, Ferro A, GiorgiRossi P, Quadrino F, Fiorina G, Capuano A, Segnan N, Fantin A. Invitation strategies for colorectal cancer screening programmes: The impact of an advance notification letter. Prev Med 2015; 73:106-11. [PMID: 25602908 DOI: 10.1016/j.ypmed.2015.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/09/2015] [Accepted: 01/11/2015] [Indexed: 11/27/2022]
Abstract
AIM To estimate the impact of an advance notification letter on participation in sigmoidoscopy (FS) and fecal immunochemical test (FIT) screening. METHODS Eligible subjects, invited in 3 Italian population based programmes using FS and in 5 using FIT, were randomised (1:1:1), within GP, to: A) standard invitation letter; B) advance notification followed after 1month by the standard invitation; and C) B+indication to contact the general practitioner (GP) to get advice about the decision to be screened. We calculated the 9-month attendance and the incremental cost of each strategy. We conducted a phone survey to assess GP's utilization and predictors of participation. RESULTS The advance notification was associated with a 20% increase in the attendance among 15,655 people invited for FS (B vs A - RR: 1.17, 95% CI: 1.10-1.25; C vs A - RR: 1.19, 95% CI: 1.12-1.27); the incremental cost ranged between 10 and 9 Euros. Participation in FIT screening (N=23,543) was increased only with simple pre-notification (B vs A - RR: 1.06, 95% CI: 1.02-1.10); the incremental cost was 22.5 Euros. GP consultation rate was not increased in group C. CONCLUSIONS An advance notification represents a cost-effective strategy to increase participation in FS screening; its impact on the response to FIT screening was limited.
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Affiliation(s)
- Carlo Senore
- AOU Città della Salute e della Scienza, CPO Piemonte, Via San Francesco da Paola 31, Torino, Italy.
| | - Andrea Ederle
- Ospedale Fracastoro, UO Gastroenterologia, Via Circonvallazione 1, S Bonifacio, VE, Italy
| | - Giovanni DePretis
- UO Gastroenterologia, Ospedale S Chiara, Largo Medaglie d'Oro 9, Trento, Italy
| | - Corrado Magnani
- Unversità del Piemonte Orientale, CPO Piemonte, Via Solaroli 1, Novara, Italy
| | - Debora Canuti
- SS Programma di Screening Oncologici AUSL Rimini, Via Coriano 38, Rimini, Italy
| | - Silvia Deandrea
- ASL Città di Milano, Servizio di Epidemiologia, Corso Italia 19, Milano, Italy
| | - Manuel Zorzi
- Registro Tumori del Veneto, Passaggio Gaudenzio 1, Padova, Italy
| | - Alessandra Barca
- Regione Lazio, Direzione Regionale Salute e Integrazione Sociosanitaria, Via Rosa Raimondi Garibaldi 7, Rome, Italy
| | | | - Katia Faitini
- UO Gastroenterologia, Ospedale S Chiara, Largo Medaglie d'Oro 9, Trento, Italy
| | - Luigi Bisanti
- ASL Città di Milano, Servizio di Epidemiologia, Corso Italia 19, Milano, Italy
| | - Coralba Casale
- SS Programma di Screening Oncologici AUSL Rimini, Via Coriano 38, Rimini, Italy
| | - Antonio Ferro
- Dipartimento di Prevenzione, ASL 17 di Este Monselice, Via Francesconi 2, Este, PD, Italy
| | - Paolo GiorgiRossi
- Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Francesco Quadrino
- Regione Lazio, Direzione Regionale Salute e Integrazione Sociosanitaria, Via Rosa Raimondi Garibaldi 7, Rome, Italy
| | - Giorgia Fiorina
- AOU Città della Salute e della Scienza, CPO Piemonte, Via San Francesco da Paola 31, Torino, Italy
| | - Arianna Capuano
- AOU Città della Salute e della Scienza, CPO Piemonte, Via San Francesco da Paola 31, Torino, Italy
| | - Nereo Segnan
- AOU Città della Salute e della Scienza, CPO Piemonte, Via San Francesco da Paola 31, Torino, Italy
| | - Alberto Fantin
- Ospedale Fracastoro, UO Gastroenterologia, Via Circonvallazione 1, S Bonifacio, VE, Italy
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Phillips CA, Green HJ, Morrissey SA. Cognitive and affective correlates of decisional balance regarding screening mammography in older women. PSYCHOL HEALTH MED 2011; 17:164-75. [PMID: 21780961 DOI: 10.1080/13548506.2011.596550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Participation in screening mammography remains suboptimal. This research aimed to improve understanding of ways to facilitate screening mammography attendance. One hundred and forty-two women from Gold Coast, Australia, aged 50-75, participated in the study. Social cognitive variables were assessed as potential predictors of mammography attendance. Most participants (79%) were maintaining regular screening mammography. Greater knowledge of breast cancer was the strongest predictor of decisional balance in favor of attending screening. Women who had relapsed from screening had significantly lower breast cancer worry than those contemplating attending for the first time. The results were consistent with previous research and point to factors screening services could consider to increase uptake.
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Affiliation(s)
- Christine A Phillips
- School of Psychology and Griffith Health Institute, Griffith University, Gold Coast, Australia
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Consedine NS, Christie MA, Neugut AI. Physician, affective, and cognitive variables differentially predict initiation versus maintenance PSA screening profiles in diverse groups of men. Br J Health Psychol 2010; 14:303-22. [DOI: 10.1348/135910708x327626] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Philip EJ, DuHamel K, Jandorf L. Evaluating the impact of an educational intervention to increase CRC screening rates in the African American community: a preliminary study. Cancer Causes Control 2010; 21:1685-91. [PMID: 20535541 DOI: 10.1007/s10552-010-9597-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 05/29/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite the acknowledged importance of colorectal cancer (CRC) screening and its proven prognostic benefit, African American men and women simultaneously possess the highest rates of CRC-related incidence and mortality (Swan et al. in Cancer 97(6):1528-1540, 2003) and lowest screening rates in the United States (Polite et al. in Med Clin N Am 89(4):771-793, 2005). Effective, targeted interventions that promote CRC screening for this community are therefore critical. The current study evaluated the impact of a print-based educational intervention on screening behavior and associated patient-based factors, including cancer-related knowledge, fatalism, worry, and decisional balance (pros-cons). METHODS One hundred and eighteen individuals (mean age = 56.08, SD = 5.58) who had not undergone screening were recruited from two health clinics in New York City. Each participant received educational print materials regarding the need for screening, the process of undergoing screening, and the benefits of regular CRC screening. RESULTS One in four individuals had undergone post-intervention screening at a three-month follow-up. Whereas all participants reported a decrease in cancer-related worry (p < .05), it was a decrease in fatalism (p < .05) and an increase in decisional balance (p < .05) that was associated with post-intervention screening behavior. DISCUSSION These preliminary results suggest that fatalistic beliefs and an individual's assessment of the benefits and barriers of screening may be critical in the decision to undergo CRC screening. Future interventions to increase CRC-screening rates for this community may be improved by focusing on these patient-based factors.
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Inconsistent mammography perceptions and practices among women at risk of breast cancer following a pediatric malignancy: a report from the Childhood Cancer Survivor Study. Cancer Causes Control 2010; 21:1585-95. [PMID: 20506037 DOI: 10.1007/s10552-010-9587-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 05/15/2010] [Indexed: 01/19/2023]
Abstract
Women treated with chest radiation for a pediatric cancer have low mammography screening rates despite their high risk for breast cancer. This study characterized the relationship between perceptions of mammography and screening practices. A cross-sectional survey was administered to 523 women in North America who were treated with chest radiation before 21 years of age. Women with inconsistent mammography perceptions and practices were identified using the Pros and Cons of Mammography for perceptions and Transtheoretical Model stages of adoption for prior and intended screening practices. Classification and regression tree (CART) analysis was used to identify barriers to and facilitators of screening among women with positive and negative perceptions. Nearly one-third of the cohort had inconsistent perceptions and practices: 37.4% had positive perceptions and were not having mammograms; 27.6% had negative/neutral perceptions and were having mammograms. Regardless of perceptions, a recent physician's recommendation for mammography, age ≥ 40, and interest in routine health care were universally associated with mammography practices. For women with positive perceptions and a physician's recommendation, barriers to screening included high acceptance coping, low active-planning coping, and high internal health locus of control. For women with negative perceptions, acknowledging the importance of asymptomatic screening was associated with mammography.
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Lin ZC, Effken JA. Effects of a tailored web-based educational intervention on women's perceptions of and intentions to obtain mammography. J Clin Nurs 2010; 19:1261-9. [PMID: 20345827 DOI: 10.1111/j.1365-2702.2009.03180.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Breast cancer is the fourth leading cause of death in Taiwanese women. Mammography has been recognised as a powerful tool for breast cancer detection. This study compared the effectiveness of a web-based tailored educational intervention based on Transtheoretical Model concepts with currently available educational information for improving Taiwanese women's perceptions and intentions to obtain mammography. BACKGROUND Despite the wide use of the Internet for health information dissemination, health information found on the web frequently is very general and not individualised or tailored to meet specific individual needs. This has produced unsatisfactory outcomes such as little to no increase in individuals' knowledge or behaviour changes. DESIGN A pretest-posttest study. Tailored intervention was hypothesised to be significantly different from standard intervention in perceptions of and intentions for Taiwanese women to receive mammography. METHODS One hundred and twenty-eight Taiwanese women were randomly assigned to one of two groups: tailored intervention or standard intervention. The tailored intervention group received a variety of educational programme tailored to the precontemplation stage for mammography based on Transtheoretical Model concepts. The standard intervention group obtained standardised mammography brochures. Interventions were given online and online questionnaires were completed by subjects at baseline and completion of interventions. RESULTS The tailored intervention group had significantly more positive perceptions of mammography and significantly more intention to obtain mammography than the standard intervention group postintervention. CONCLUSIONS This study contributes to our knowledge of how a health education website can enhance women's mammography-related positive perceptions and intentions if tailored to their readiness for change. RELEVANCE TO CLINICAL PRACTICE Increasingly, people get their health information from the web. If that education is also tailored to individual needs, it can have a greater impact on their health care decisions.
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Affiliation(s)
- Zu-Chun Lin
- Department of Nursing, Tzu-Chi College of Technology, Hualien, Taiwan
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13
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A tailored web-based intervention to promote women's perceptions of and intentions for mammography. J Nurs Res 2010; 17:249-60. [PMID: 19955881 DOI: 10.1097/jnr.0b013e3181c15a38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Internet is rapidly becoming an accepted standard for disseminating and obtaining health information. However, health information presented on the Web frequently is neither tailored to patients' characteristics nor theoretically driven. This study used Prochaska's transtheoretical model to guide the design and evaluation of a tailored Web-based mammography educational program. PURPOSE This study used a pretest-posttest design to examine the impact of a tailored Web-based educational intervention on women's perceptions of and intentions to obtain a mammography. We hypothesized that a complete tailored intervention (CTI) would result in a significantly higher score than that of tailored message intervention (TMI) in terms of women's perceptions of mammography and intentions to receive a mammography. Both TMI and CTI have been found to have significantly higher scores in terms of women's perceptions of mammography and intentions to receive a mammography than those of the standard intervention (SI). METHODS One hundred eighty-five women were assigned randomly to one of three groups: CTI (n = 61), TMI (n = 63), or SI (n = 61). Online questionnaires were completed by participants at baseline and after completion of intervention. RESULTS Study results supported the hypothesis of perceptions of mammography. The CTI group had significantly higher scores on intention to obtain a mammogram than those of the SI group. However, the differences between CTI and TMI groups and between TMI and SI groups were not significant. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Results of the study validated the importance of utilizing theory for tailored intervention design to enhance individuals' positive perceptions of health behaviors. Additional studies should consider the effect of various processes and activities on women at different stages of acceptance of the need to obtain a mammogram to further determine outcomes and apply such to mammography screening behavior.
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Rini C, O'Neill SC, Valdimarsdottir H, Goldsmith RE, Jandorf L, Brown K, DeMarco TA, Peshkin BN, Schwartz MD. Cognitive and emotional factors predicting decisional conflict among high-risk breast cancer survivors who receive uninformative BRCA1/2 results. Health Psychol 2009; 28:569-578. [PMID: 19751083 DOI: 10.1037/a0015205] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate high-risk breast cancer survivors' risk reduction decision making and decisional conflict after an uninformative BRCA1/2 test. DESIGN Prospective, longitudinal study of 182 probands undergoing BRCA1/2 testing, with assessments 1-, 6-, and 12-months postdisclosure. MEASURES Primary predictors were health beliefs and emotional responses to testing assessed 1-month postdisclosure. Main outcomes included women's perception of whether they had made a final risk management decision (decision status) and decisional conflict related to this issue. RESULTS There were four patterns of decision making, depending on how long it took women to make a final decision and the stability of their decision status across assessments. Late decision makers and nondecision makers reported the highest decisional conflict; however, substantial numbers of women--even early and intermediate decision makers--reported elevated decisional conflict. Analyses predicting decisional conflict 1- and 12-months postdisclosure found that, after accounting for control variables and decision status, health beliefs and emotional factors predicted decisional conflict at different timepoints, with health beliefs more important 1 month after test disclosure and emotional factors more important 1 year later. CONCLUSION Many of these women may benefit from decision making assistance.
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Relationships between decisional balance and stage of adopting mammography and Pap testing among Chinese American women. Cancer Epidemiol 2009; 33:374-80. [PMID: 19900848 DOI: 10.1016/j.canep.2009.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 04/21/2009] [Accepted: 10/06/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Transtheoretical Model has not been applied to explain cancer screening behavior among a large sample of Chinese Americans. This study examines the stage of adopting mammography and Pap testing in relation to women's decisional balance of cancer screening. METHODS We surveyed a sample of 507 Chinese American women aged 50 and older in the DC area in 2003 and 2004. We categorized women into six screening stages (pre-contemplation, contemplation, action, relapse, risk of relapse, and maintenance) based on the frequency and regularity of past screening behaviors and future intentions. We measured women's attitudes toward mammography and Pap testing by 22 pro and con statements. Decisional balance was calculated by the mean difference between pro and con scores. Multinomial regression analyses were used to examine the associations between decisional balance and stage of adoption, controlling for sociodemographics, English fluency, and physician and family recommendations. RESULTS Maintenance was the largest group among six stages (45% for mammography; 44% for Pap testing). Women in the maintenance group had the highest decisional balance scores, indicating more positive attitudes toward screening. Decisional balance was significantly related to stages of adopting mammograms and Pap testing after adjusting for other covariates. CONCLUSIONS This study demonstrated that Chinese American women's cancer screening behavior was associated with decisional balance, as described in the Transtheoretical Model. Cancer screening messages should be tailored to the needs of women in different stages of adopting mammography and Pap testing.
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Trauth JM, Ling BS, Weissfeld JL, Schoen RE, Hayran M. Using the transtheoretical model to stage screening behavior for colorectal cancer. HEALTH EDUCATION & BEHAVIOR 2009; 30:322-36. [PMID: 19731499 DOI: 10.1177/1090198103030003007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study sought to describe the colorectal cancer (CRC)-screening behavior of a population of two lower income communities near Pittsburgh, Pennsylvania. The transtheoretical model was used to characterize individuals according to their stage of readiness to engage in one of two recommended CRC screening tests--the Fecal Occult Blood Test (FOBT) or Flexible Sigmoidoscopy (FSG) test. A telephone survey was conducted of 50- to 79-year-old men and women in Aliquippa and Clairton in the spring of 1999. Analyses based on 414 survey respondents showed associations between FOBT or FSG behavioral stage and factors including gender, age, recent doctor checkup, chronic need for prescription medications, history of cervical Pap smear testing, history of prostate-specific antigen blood testing, and prior doctor recommendation in favor of FOBT or FSG testing. This study appears to be one of the first applications of this theory to understanding CRC screening behavior in a community intervention.
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Affiliation(s)
- Jeanette M Trauth
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Wu TY, Hsieh HF, West BT. Stages of mammography adoption in Asian American women. HEALTH EDUCATION RESEARCH 2009; 24:748-759. [PMID: 19318524 DOI: 10.1093/her/cyp009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Asian American women have the lowest mammography screening rate and are often diagnosed at later stages of breast cancer compared with other ethnic groups. This study applied the Transtheoretical Model and examined the relationships between stages of mammography adoption and mammography-related beliefs while controlling for socio-demographic factors. The study consisted of a convenience sample of 315 participants from four populous Asian ethnic groups in Michigan (109 Asian Indians, 51 Chinese, 36 Koreans and 119 Filipinos). In this relatively small sample, Koreans appeared to be more likely to be at the pre-contemplation stage and less likely to be at the maintenance stage. Perceived barriers and decisional balance scores differed by stage, with pre-contemplators reporting highest barriers and lowest scores in decisional balance. In terms of specific barrier items, pre-contemplators also displayed significantly greater agreement for most of the barrier items. Participants in the action stage have less favorable decisional balance than those in two earlier stages (i.e. contemplation and relapse). Common barriers for this sample of Asian participants included the items related to access and modesty issues. Overall, the study supports the notion that assessing differences in mammography-related beliefs by stage of screening behavior may facilitate the development of stage-matched interventions for Asian ethnic groups.
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Affiliation(s)
- Tsu-Yin Wu
- School of Nursing, Eastern Michigan University, Ypsilanti, MI 48197, USA.
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Kwak MS, Choi KS, Spring BJ, Park S, Park EC. Predicting the stages of adoption of cervical cancer screening among Korean women. Prev Med 2009; 49:48-53. [PMID: 19465046 DOI: 10.1016/j.ypmed.2009.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 05/13/2009] [Accepted: 05/15/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We examined the Transtheoretical Model (TTM) of behavioral change based on cervical cancer screening among Korean women. We assessed the stages of Pap smear adoption, positive and negative attitudes toward Pap smear, and contributory factors. METHOD This study was based on the 2007 Korean National Cancer Screening Survey, which included a total of 1224 women > or =30 years. Multiple logistic analyses were conducted to determine the factors that influenced the women's stages of adoption. RESULTS Fifty-seven percent of the women reported on-schedule screening while 43% did not. Those subjects who were 50-64 years old, had higher incomes, married, lived in a rural area, exercised regularly, and had regular checkups were more likely to be in maintenance than in precontemplation. However, the con scores were negatively associated with a transition from precontemplation to maintenance. Further, a high con score was associated with being in relapse risk or relapse rather than in maintenance while the pro scores were not significant across the stages of adoption. CONCLUSION Our results confirm the applicability of the TTM to Pap smear screening in an Asian context. Age, income, marital status, residency, regular exercise, health checkups, and con scores were significantly associated with the stage of adoption.
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Affiliation(s)
- Min-Son Kwak
- National Cancer Control Institute, National Cancer Center, Gyeonggi-do, Republic of Korea
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Fernández ME, Gonzales A, Tortolero-Luna G, Williams J, Saavedra-Embesi M, Chan W, Vernon SW. Effectiveness of Cultivando la Salud: a breast and cervical cancer screening promotion program for low-income Hispanic women. Am J Public Health 2009; 99:936-43. [PMID: 19299678 DOI: 10.2105/ajph.2008.136713] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the effectiveness of a lay health worker intervention to increase breast and cervical cancer screening among low-income Hispanic women. METHODS Participants were women 50 years and older who were nonadherent to mammography (n = 464) or Papanicolaou (Pap) test (n = 243) screening guidelines. After the collection of baseline data, lay health workers implemented the Cultivando la Salud (CLS; Cultivating Health) intervention. Data collectors then interviewed the participants 6 months later. RESULTS At follow-up, screening completion was higher among women in the intervention group than in the control group for both mammography (40.8% vs 29.9%; P < .05) and Pap test (39.5% vs 23.6%; P < .05) screening. In an intent-to-treat analysis, these differences remained but were not significant. The intervention increased mammography self-efficacy, perceived susceptibility, perceived survivability, perceived benefits of mammography, subjective norms, and processes of change. The intervention also significantly increased Pap test self-efficacy, perceived benefits of having a Pap test, subjective norms, and perceived survivability of cancer. It did not change Pap test knowledge, perceived susceptibility, or perceptions about negative aspects of Pap test screening. CONCLUSIONS Our results add to the evidence concerning the effectiveness of lay health worker interventions for increasing Pap test screening and mammography. Future research should explore the effectiveness of CLS in other Hispanic groups, the mechanisms through which interpersonal communication influences decisions about screening, and how effective interventions such as CLS can best be adopted and implemented in community-based organizations or other settings.
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Affiliation(s)
- María E Fernández
- Center for Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center, 7000 Fannin St, Suite 2558, Houston, TX 77030, USA.
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Mediating Effects of Self-Efficacy in the Transtheoretical Model Among Adolescent Male Smokers in Korea. Asian Nurs Res (Korean Soc Nurs Sci) 2009; 3:15-23. [DOI: 10.1016/s1976-1317(09)60012-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 01/12/2009] [Accepted: 03/06/2009] [Indexed: 11/22/2022] Open
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Oeffinger KC, Ford JS, Moskowitz CS, Diller LR, Hudson MM, Chou JF, Smith SM, Mertens AC, Henderson TO, Friedman DL, Leisenring WM, Robison LL. Breast cancer surveillance practices among women previously treated with chest radiation for a childhood cancer. JAMA 2009; 301:404-14. [PMID: 19176442 PMCID: PMC2676434 DOI: 10.1001/jama.2008.1039] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
CONTEXT Women treated with chest radiation for a pediatric malignancy have a significantly increased risk of breast cancer at a young age and are recommended to have an annual screening mammogram starting at age 25 years or 8 years after radiation, whichever occurs last. OBJECTIVE To characterize the breast cancer surveillance practices among female pediatric cancer survivors who were treated with chest radiation and identify correlates of screening. DESIGN, SETTING, AND PARTICIPANTS Between June 2005 and August 2006, a 114-item questionnaire was administered to a random sample of 625 women aged 25 through 50 years who had survived pediatric cancer, who had been treated with chest radiation, and who were participating in the Childhood Cancer Survivor Study (CCSS), a North American cohort of long-term survivors diagnosed from 1970-1986. Comparisons were made with similarly aged pediatric cancer survivors not treated with chest radiation (n = 639) and the CCSS siblings cohort (n = 712). MAIN OUTCOME MEASURE Screening mammogram within the previous 2 years. RESULTS Of 1976 cancer survivors and siblings who were contacted, 87.9% participated. Among the 551 women with a history of chest radiation, 55% reported a screening mammogram in the past 2 years (ages 25-39 years, 36.5%; 95% confidence interval [CI], 31.0%-42.0%; ages 40-50 years, 76.5%; 95% CI, 71.3%-81.7%). In comparison, 40.5% of survivors without chest radiation and 37.0% of CCSS siblings reported a screening mammogram in the same time interval. Notably, among women with a history of chest radiation, 47.3% (95% CI; 41.6%-53.0%) of those younger than 40 years had never had a mammogram and only 52.6% (95% CI; 46.4%-58.8%) of women aged 40 through 50 years were being regularly screened (2 mammograms within 4 years). Screening rates were higher among women who reported a physician recommendation than those who did not (ages 25-39 years, 76.0% vs 17.6%; ages 40-50 years, 87.3% vs 58.3%). In multivariate models, the association was particularly strong for younger women (ages 25-39 years, prevalence ratio [PR], 3.0; 95% CI, 2.0-4.0; ages 40-50 years, PR, 1.3; 95% CI, 1.1-1.6). CONCLUSIONS In this cohort of women who had childhood cancer treated with chest radiation, 63.5% of those aged 25 through 39 years and 23.5% of those aged 40 through 50 years had not had mammography screening for breast cancer within the previous 2 years despite a guideline recommendation that survivors of childhood cancer who were treated with chest radiation should undergo annual screening mammography.
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Affiliation(s)
- Kevin C Oeffinger
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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McQueen A, Tiro JA, Vernon SW. Construct validity and invariance of four factors associated with colorectal cancer screening across gender, race, and prior screening. Cancer Epidemiol Biomarkers Prev 2008; 17:2231-7. [PMID: 18768488 PMCID: PMC2603464 DOI: 10.1158/1055-9965.epi-08-0176] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Understanding individuals' perceptions of colorectal cancer screening (CRCS) is important for developing effective interventions to increase adherence to screening guidelines. Theory-based cognitive and psychosocial constructs have been associated with CRCS in the literature, but few studies have evaluated the psychometric properties of such measures. We hypothesized a correlated four-factor model, including CRCS perceived pros, cons, social influence, and self-efficacy. We also examined measurement invariance across subgroups based on gender, race (white; African American), and prior CRCS experience (never; overdue for repeat screening). We used baseline (n = 1,250) and 2-week (n = 1,036) follow-up survey data from participants in a behavioral intervention trial designed to increase CRCS. Only minor modifications were made to the hypothesized model to improve fit, and the final model was confirmed with a random half of the sample, as well as with follow-up data. Results support the hypothesized unidimensional construct measures and suggest that the items may be appropriate for all subgroups examined. Greater variance in responses to items assessing the perceived cons of CRCS was found among African Americans compared with whites, suggesting that race may moderate the association between perceived cons and CRCS in this sample. Pros, cons, social influence, and self-efficacy are associated with CRCS; therefore, using scales with known psychometric properties strengthens researchers' ability to draw conclusions about group differences and changes over time and to compare their results with other studies. Replication studies in other populations are needed to provide further evidence of construct validity for the scales reported here.
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Affiliation(s)
- Amy McQueen
- Division of Health Behavior Research, Washington University School of Medicine, St. Louis, MO 63108, USA.
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Kang HS, Thomas E, Kwon BE, Hyun MS, Jun EM. Stages of change: Korean women's attitudes and barriers toward mammography screening. Health Care Women Int 2008; 29:151-64. [PMID: 18350421 DOI: 10.1080/07399330701738176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The positive and negative aspects of breast cancer screening were measured to gain insight into the barriers that prevent Korean women from participating in mammography screening. Breast cancer screening behaviors, attitudes, and barriers were identified from a convenience sample of 328 Korean women recruited in Seoul, Gyeonggi, and Jeju, South Korea. Pros, cons, and decisional balance constructs of the transtheoretical model of behavior change were used to identify stages of change in attitude related to mammography screening. There were significant differences in pros (F = 5.175, p = .001) and cons (F = 3.357, p = .012) across the five stages of change for mammography. Participants indicated that the major barriers to mammography screening were, in order of frequency, the belief that an absence of symptoms meant there was no need for a breast examination, the high cost of breast cancer screening, lack of time, lack of information, embarrassment, fear about x-rays and test results, reliance on breast self-examination (BSE), and discomfort or pain. The benefits of breast cancer screening should be emphasized among Korean women.
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Affiliation(s)
- Hee Sun Kang
- Department of Nursing, College of Medicine, Chung-Ang University, Seoul, Korea
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Reasons for non-attendance in cervical cancer screening programmes: an application of the Integrated Model for Behavioural Change. Eur J Cancer Prev 2007; 16:436-45. [DOI: 10.1097/01.cej.0000236250.71113.7c] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wu TY, West BT. Mammography Stage of Adoption and Decision Balance Among Asian Indian and Filipino American Women. Cancer Nurs 2007; 30:390-8. [PMID: 17876185 DOI: 10.1097/01.ncc.0000290812.14571.2c] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cancer is the leading cause of death among Asian American women, and the death rate has increased almost 200% since 1990. Previous research has applied the transtheoretical model constructs to examine cancer screening behavior; however, to our knowledge, this is the first such investigation to examine relationships between stages of mammography adoption and decision balance among Asian American women. This article presents study findings from a convenience sample of 228 women aged 40 to 81 years (mean = 55.0, SD = 9.6) residing in southeastern Michigan. The current study demonstrates excellent support for the psychometric properties of a pros and cons measure, with promising Cronbach alphas above .70. Results from confirmatory factor analysis also support the factor structure derived from exploratory factor analysis with good model fit indices. This study also provides some support on transtheoretical model-hypothesized relationships in this sample of Asian American women that, as the stages of adoption of mammography proceeded from earlier to later ones, the decisional balance would become more favorable. The specific beliefs (both positive and negative) associated with the various stages of mammography adoption have implications for health professionals in developing stage-matched interventions to motivate women in adopting regular mammography.
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Affiliation(s)
- Tsu-Yin Wu
- School of Nursing, Eastern Michigan University, Ypsilanti, Mich 48197, USA.
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Ham OK, Lee YJ. Use of the transtheoretical model to predict stages of smoking cessation in Korean adolescents. THE JOURNAL OF SCHOOL HEALTH 2007; 77:319-26. [PMID: 17600589 DOI: 10.1111/j.1746-1561.2007.00213.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Smoking is popular among Korean male high school adolescents, with the prevalence of 20.7% differing markedly with the type of school, being 16.3% and 27.6% in academic and vocational technical high schools, respectively. The purpose of this study was to identify significant variables that predict stages of smoking cessation among Korean high school students using the transtheoretical model (TTM), in order to provide an empirical basis for developing smoking cessation programs. METHODS Cross-sectional data were collected in April and May 2004 from 300 male students at 3 vocational technical high schools in Korean metropolitan areas. The survey variables comprised decisional balance, self-efficacy, stages and processes of change, nicotine dependence, and use of smoking cessation aids. RESULTS Current and former smokers comprised 26.3% and 22.7% of the cohort, respectively, of which 71.4% had experienced smoking cessation at least once and 55.1% utilized smoking cessation aids to help stop smoking. Nicotine-free tobacco and nicotine gum were the most common smoking cessation aids. Decisional balance, use of behavioral processes, and higher self-efficacy were significant in explaining stages of smoking cessation after controlling for nicotine dependence. CONCLUSIONS The study results suggest that smoking cessation programs developed based on the TTM may help adolescents to progress through stages, with it being important to include information regarding the use of smoking cessation aids.
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Affiliation(s)
- Ok Kyung Ham
- Department of Nursing, Inha University, Nam-Gu, Incheon, Republic of Korea.
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Arredondo EM, Pollak K, Costanzo PR. Evaluating a stage model in predicting monolingual spanish-speaking Latinas' cervical cancer screening practices: the role of psychosocial and cultural predictors. HEALTH EDUCATION & BEHAVIOR 2007; 35:791-805. [PMID: 17652618 DOI: 10.1177/1090198107303250] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goals of this study are to evaluate (a) the effectiveness of a stage model in predicting Latinas' self-report of obtaining a Pap test and (b) the unique role of psychosocial/cultural factors in predicting progress toward behavior change. One-on-one structured interviews with monolingual Spanish-speaking Latinas (n=190) were conducted. Most participants (85%) intended to obtain a Pap smear within 1 year; therefore, staging women based on intention was not possible. Moreover, results from the polychotomous hierarchical logistic regression suggest that psychosocial and cultural factors were independent predictors of Pap test history. A stage model may not be appropriate for predicting Pap test screening among Latinas. Results suggest that unique cultural, psychosocial, and demographic factors may inhibit cervical cancer screening practices. Clinicians may need to tailor messages on these cultural and psychosocial factors to increase Pap testing among Latinas.
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Nash D, Chan C, Horowitz D, Vlahov D. Barriers and missed opportunities in breast and cervical cancer screening among women aged 50 and over, New York City, 2002. J Womens Health (Larchmt) 2007; 16:46-56. [PMID: 17324096 DOI: 10.1089/jwh.2006.0079] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Breast and cervical cancer screening both are routinely recommended for women. However, data are sparse on factors associated with joint screening behaviors. Our objective to describe the factors associated with receiving both, one, or neither screening test among women aged > or = 50. METHODS Using data from the New York City Community Health Survey (NYC CHS), we compared the characteristics of women > age 50 (n = 2059) who missed (1) a Pap smear only, (2) mammography only, or (3) both screening procedures with the characteristics of women who received both tests. Analyses were performed using multiple logistic regression. RESULTS Seventy-three percent of women had both screening tests, 6.7% needed a Pap smear only, 10% missed mammography only, and 10% missed both tests. After multiple logistic regression, missing a Pap smear only was more likely among women > 70 years compared with younger women and among women from Queens than from Manhattan. Missing mammography only was more common among women not reporting a personal doctor than among those with a doctor and among uninsured women relative to the privately insured. Missing both tests was more common among women > 74 years, current smokers compared with never smokers, women without a personal doctor, and the uninsured. This was less common among women from the Bronx than women from Manhattan and among racial/ethnic minorities compared with non-Hispanic white women. CONCLUSIONS The predictors of each screening outcome appear to be qualitatively different. Changes in provider practices and targeted education may improve Pap smear screening rates, whereas policy initiatives and increased access for the uninsured may raise mammography rates. To achieve optimal preventive care, coscreening should be considered.
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Affiliation(s)
- Denis Nash
- The Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York, USA.
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Des Jarlais DC, Arasteh K, Perlis T, Hagan H, Heckathorn DD, Mcknight C, Bramson H, Friedman SR. The transition from injection to non-injection drug use: long-term outcomes among heroin and cocaine users in New York City. Addiction 2007; 102:778-85. [PMID: 17506155 DOI: 10.1111/j.1360-0443.2007.01764.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS To characterize heroin and cocaine users in New York City who have changed from injection to non-injection drug administration and to identify factors associated with long-term non-injection use. DESIGN Two cross-sectional studies of heroin and cocaine users in New York City. SETTINGS AND PARTICIPANTS New admissions were recruited at drug abuse treatment programs (2000-04) and respondent-driven sampling was used to recruit drug users from the community (2004). Both injecting and non-injecting drug users participated in each study. 'Former injectors' were defined operationally as people who had used heroin and/or cocaine in the 6 months prior to the interview and who had injected illicit drugs in the past, but whose most recent injection was more than 6 months before the study interview. 'Current' injectors were defined as people who had injected heroin and/or cocaine in the 6 months prior to the interview. MEASUREMENTS A structured interview on drug use history was administered, and a serum sample was collected and tested for the human immunodeficiency virus (HIV). FINDINGS A total of 104 former injectors was recruited for the drug abuse treatment program study, and 229 current injectors were recruited for the community recruitment study; 160 former injectors and 1731 current injectors were recruited from the drug abuse treatment study. Compared with the current injectors, former injectors were older and more likely to be African American. The former injectors reported long intervals since their most recent injection, a mean of 8 years in the drug abuse treatment program study and a mean of 12 years in the community recruitment study. The most common reasons for stopping injection drug use included concerns about health, social stigmatization and self-image, and preference for intranasal use as a route of drug administration. The results were highly consistent across the two studies. CONCLUSIONS The transition from injection to non-injection use appears to be relatively stable behavior change for many former injectors, who report a decade or more without injecting. Developing a greater understanding of the transition from injection to stable non-injection drug use may provide insights into the natural histories of drug use and addiction.
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Affiliation(s)
- Don C Des Jarlais
- Beth Israel Medical Center, Baron Edmond de Rothschild Chemical Dependency Institute, New York, NY 10038, USA.
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Mullen PD, Allen JD, Glanz K, Fernandez ME, Bowen DJ, Pruitt SL, Glenn BA, Pignone M. Measures used in studies of informed decision making about cancer screening: a systematic review. Ann Behav Med 2007; 32:188-201. [PMID: 17107291 DOI: 10.1207/s15324796abm3203_4] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Interventions to promote informed decision making (IDM) for cancer screening are increasingly common. The resulting body of literature provides an opportunity for a systematic review of measures in use. We searched standard databases for intervention trials and other studies of screening decisions and decision aids, finding 2,110 unique citations (most with abstracts) that we reduced to 104 full-text articles; 36 studies met inclusion criteria (prostate = 20, colorectal = 9, breast = 6, cervical = 1). Two independent coders abstracted data on study characteristics, constructs, and measures. Our findings revealed that most studies measured screening (or intention) and knowledge; fewer measured recommended IDM-related constructs and none measured all outcomes proposed for evaluating IDM interventions. Validity and reliability of measures received inadequate attention in study reports, and conceptual overlap exists among measures. Few IDM measures have been developed/carefully adapted from treatment measures and tested for cancer screening or in diverse populations. We recommend that new and in-progress studies emphasize outcomes beyond knowledge-participation in decision making according to personal preference, satisfaction with the process, and consistency between decisions and values. Also needed is better use of theory to guide conceptualization and operationalization of measures, greater attention to reliability and validity (particularly in diverse populations), more thorough reporting of sources and operating characteristics of measures, and increased emphasis and resources focused on these issues by funders, researchers, and journal editors.
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Russell KM, Monahan P, Wagle A, Champion V. Differences in health and cultural beliefs by stage of mammography screening adoption in African American women. Cancer 2007; 109:386-95. [PMID: 17133417 DOI: 10.1002/cncr.22359] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Behavioral studies show that women's stage of readiness to adopt mammography screening affects their screening rates and that beliefs about breast cancer and screening affect stages of screening. The purposes of this study were to determine, first, the relationship between particular health and cultural beliefs and stage of mammography screening adoption in urban African American women, and second, whether demographic and experiential characteristics differed by stage. Data were analyzed from 344 low-income African American women nonadherent to mammography screening who participated in a 21-month trial to increase screening. At baseline, these women were randomized into 1 of 3 groups: tailored interactive computer instruction, targeted video, or usual care. Participants were categorized by stage of mammography screening adoption at 6 months as precontemplators (not planning to have a mammogram), contemplators (planning to have a mammogram), or actors (had received a mammogram). Although demographic and experiential variables did not differentiate stages of screening adoption at 6 months postintervention, some health and cultural beliefs were significantly different among groups. Actors were more preventive-health-oriented than precontemplators and had fewer barriers to screening than did contemplators. Precontemplators had more barriers, less self-efficacy, and greater discomfort with the mammography screening environment than did contemplators or actors. These results will be useful, not to change cultural beliefs, but to guide the design of health education messages appropriate to an individual's culture and health belief system. Cancer 2007. (c) 2006 American Cancer Society.
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Affiliation(s)
- Kathleen M Russell
- Department of Environments for Health, School of Nursing, Indiana University, Indianapolis, Indiana 46202, USA.
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Otero-Sabogal R, Stewart S, Shema SJ, Pasick RJ. Ethnic differences in decisional balance and stages of mammography adoption. HEALTH EDUCATION & BEHAVIOR 2006; 34:278-96. [PMID: 16891624 PMCID: PMC2939724 DOI: 10.1177/1090198105277854] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral theories developed through research with mainstream, English-speaking populations have been applied to ethnically diverse and underserved communities in the effort to eliminate disparities in early breast cancer detection. This study tests the validity of the transtheoretical model (TTM) decisional balance measure and the application of the TTM stages of change in a multiethnic, multilingual sample. A random sample of 1,463 Filipino, Latino, African American, Chinese, and White women aged 40 to 74 completed a phone survey of mammography beliefs and practices. Consistent with the TTM and independent of ethnicity, decisional balance was associated with mammography stage in all five ethnic groups when controlling for socioeconomic and other factors. In addition, having private insurance and a regular physician and being a long-time resident in the United States were positively associated with mammography maintenance. The application of the TTM for mammography is supported in a multiethnic and multilingual sample.
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Affiliation(s)
- Regina Otero-Sabogal
- Institute for Health and Aging, University of California-San Francisco, CA 94143-0646, USA.
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Juon HS, Choi S, Klassen A, Roter D. Impact of breast cancer screening intervention on Korean-American women in Maryland. ACTA ACUST UNITED AC 2006; 30:297-305. [PMID: 16870356 DOI: 10.1016/j.cdp.2006.03.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adherence to mammography guidelines among Korean-American women (KAW) is lower than that of Caucasian-Americans, and disparities in breast cancer screening related to lack of English proficiency is under-researched. This study examined the impact of a breast cancer intervention on intentions to use mammography among KAW. METHODS Face-to-face pre-intervention surveys were conducted in control (n=95) and intervention groups (n=105), and were followed by implementation of a breast cancer education program. At 6 months, both groups were re-interviewed by phone (92 control and 94 intervention participants). Generalized estimating equation (GEE) analysis was used to assess the intervention effect before and after the breast cancer educational program. RESULTS The intervention effect was statistically significant. Women in the intervention reported 2.96 times greater posttest intentions to have mammogram than those in the control group (95% CI, 1.13-7.66). Prior intentions, age, and positive attitudes toward mammography were associated with follow-up intentions to have a mammogram. CONCLUSION This culturally and linguistically tailored educational intervention was effective in increasing breast cancer awareness in a non-English speaking population.
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Affiliation(s)
- Hee-Soon Juon
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Tiro JA, Diamond PM, Perz CA, Fernandez M, Rakowski W, DiClemente CC, Vernon SW. Validation of scales measuring attitudes and norms related to mammography screening in women veterans. Health Psychol 2006; 24:555-66. [PMID: 16287401 DOI: 10.1037/0278-6133.24.6.555] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Validation of psychosocial measures for use in mammography screening research has been given inadequate attention in the literature. The authors report on the validation of 5 measures examining 4 attitudinal constructs (i.e., pros, cons, outcome expectations, and cancer worries) and 1 social influence construct (i.e., subjective norms) in a 22-item inventory. The study participants consisted of a national, randomly sampled population of women veterans (n = 2,910). After minor revision of scales, the authors found independent measures for 4 constructs: pros, cons, cancer worries, and subjective norms. The authors concluded that these scales have acceptable psychometric properties; support construct validity; and provide brief, reliable, and valid measures of attitudes toward and norms regarding mammography screening. These scales may be useful for intervention research.
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Affiliation(s)
- Jasmin A Tiro
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health at Houston, TX, USA.
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Taylor SD. Predictive genetic test decisions for Huntington's disease: elucidating the test/no-test dichotomy. J Health Psychol 2005; 10:597-612. [PMID: 16014395 DOI: 10.1177/1359105305053442] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Predictive genetic testing for serious, mature-onset genetic illness represents a unique context in health decision making. This article presents findings from an exploratory qualitative Australian-based study into the decision making of individuals at risk for Huntington's disease (HD) with regard to predictive genetic testing. Sixteen in-depth interviews were conducted with a range of at-risk individuals. Data analysis revealed four discrete decision-making positions rather than a 'to test' or 'not to test' dichotomy. A conceptual dimension of (non-)openness and (non-)engagement characterized the various decisions. Processes of decision making and a concept of 'test readiness' were identified. Findings from this research, while not generalizable, are discussed in relation to theoretical frameworks and stage models of health decision making, as well as possible clinical implications.
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Affiliation(s)
- Sandra D Taylor
- School of Social Work & Applied Human Sciences, University of Queensland, Brisbane, Australia.
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Hou SI, Luh WM. Psychometric Properties of the Cervical Smear Belief Inventory for Chinese Women. Int J Behav Med 2005; 12:180-91. [PMID: 16083321 DOI: 10.1207/s15327558ijbm1203_7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study examines the reliability and validity of the scores of Cervical Smear Belief Inventory (CSBI) among Chinese women in Taiwan. Women who were nonadherent to cervical screening guidelines were recruited (N = 424). Reliabilities showed good internal consistency for the perceived Pros, Cons, and Susceptibility scales (a ranged from .78 to .87). Factor analysis showed good construct validity of the scores of CSBI that revealed concordant patterns with existing social and behavioral theories, except that the Norms scale was loaded with the Pros scale. Moreover, two items in the Cons scale appeared to be "cultural belief toward virginity." Item-discrimination analysis showed that all items in the CSBI successfully discriminated women with favorable cervical smear beliefs from those with unfavorable beliefs (p < .001). In summary, many psychometric properties of the CSBI showed that the scores of the inventory were reliable and valid to assess belief toward cervical smear among Chinese women.
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Affiliation(s)
- Su-I Hou
- Department of Health Promotion and Behavior, The University of Georgia, Athens, Georgia 30602-6522, USA.
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Denberg TD, Wong S, Beattie A. Women's misconceptions about cancer screening: implications for informed decision-making. PATIENT EDUCATION AND COUNSELING 2005; 57:280-5. [PMID: 15893209 DOI: 10.1016/j.pec.2004.07.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2004] [Revised: 07/15/2004] [Accepted: 07/15/2004] [Indexed: 05/02/2023]
Abstract
Informed decision-making about cancer screening requires that patients have a correct understanding of a test's purpose, benefits, and risks. Misconceptions, however, may be common. Semi-structured interviews were carried out and thematically coded using a purposive sample of 24 socioeconomically diverse white, African American, Latino and Chinese American women recruited from general medicine practices and community settings. Interviews focused on participants ideas related to cancer prevention and screening. Women expressed cancer-related beliefs characterized by inaccuracies, distortions, and over-simplifications. Many of these beliefs may go unrecognized in clinical settings yet have a profound influence on risk communication and, therefore, informed decision-making. Effective communication depends, first, on clinicians and patients sharing an accurate understanding of background concepts such as "prevention," "screening," and "cancer."
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Affiliation(s)
- Thomas D Denberg
- Division of General Internal Medicine, University of Colorado Health Sciences Center, B-180, Denver, CO 80262, USA.
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Thompson HS, Valdimarsdottir HB, Winkel G, Jandorf L, Redd W. The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening. Prev Med 2004; 38:209-18. [PMID: 14715214 DOI: 10.1016/j.ypmed.2003.09.041] [Citation(s) in RCA: 297] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is little research on medical mistrust as a barrier to breast cancer screening. This study investigated the psychometric properties of a new scale, the Group-Based Medical Mistrust Scale (GBMMS), and its association with cancer screening attitudes and breast cancer screening practices among African American and Latina women. METHODS Participants were 168 African American and Latina urban women who completed the GBMMS and measures of sociodemographics, cancer screening pros and cons, acculturation, breast cancer screening practices and physician recommendation of such screening. RESULTS A principal components analysis of GBMMS items revealed three factors that were analyzed as subscales: (1) suspicion, (2) group disparities in health care, and (3) lack of support from health care providers. Convergent validity of the GBMMS was supported by its negative association with perceived benefits of cancer screening and acculturation and positive association with perceived disadvantages of cancer screening. Results further showed that women who reported no previous mammogram or a long-term lapse in mammography participation (>5 years) had significantly higher total GBMMS scores (P < 0.04) compared to women who were either adherent to mammography guidelines or nonadherent but reported a mammogram within the past 5 years. This analysis controlled for physician recommendation. CONCLUSIONS Results support the validity of the GBMMS and its association with breast cancer screening adherence. The GBMMS may be used to further investigate medical mistrust as a barrier to screening for cancers for which ethnic group disparities have been observed.
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Affiliation(s)
- Hayley S Thompson
- Ruttenberg Cancer Center, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1130, New York, NY 10029, USA.
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Valdez A, Banerjee K, Ackerson L, Fernandez M, Otero-Sabogal R, Somkin CP. Correlates of breast cancer screening among low-income, low-education Latinas. Prev Med 2001; 33:495-502. [PMID: 11676592 DOI: 10.1006/pmed.2001.0913] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This paper discusses the factors associated with breast cancer screening among low-education, low-income Latinas. BACKGROUND These data were collected as part of a breast cancer educational intervention study aimed at this population. The objective of the larger study was to evaluate multimedia methods as an appropriate medium for educating this population of Latinas about breast cancer. METHODS The study was designed as a field experiment with a pre and posttest design. A total of 1,197 individuals participated in the study, and these were all self-identified Latinas above the age of 40 years who fit the screening criteria of low income and education levels. Of these, 583 individuals provided the baseline (pretest) data on mammogram attitudes, knowledge, and intentions analyzed in this paper. RESULTS Our results indicate that breast cancer screening knowledge and having a regular doctor were significant factors in ever having had a mammogram and having had a recent mammogram in this sample of low-income, low-education Latinas. Age affected the odds of ever having had a mammogram, but not a recent mammogram. CONCLUSION Attitudes toward mammography, insurance status, and demographic factors such as foreign birth were not significant predictors of mammography screening in this study.
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Affiliation(s)
- A Valdez
- Valdez & Associates, 201 San Antonio Circle, Suite 152, Mountain View, California 94040, USA.
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Newell SA, Girgis A, Sanson-Fisher RW, Savolainen NJ. The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review. Am J Prev Med 1999; 17:211-29. [PMID: 10987638 DOI: 10.1016/s0749-3797(99)00069-0] [Citation(s) in RCA: 258] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To critically review the literature concerning the accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease among the general population. METHOD A literature search was conducted on three major health research databases: MEDLINE, HealthPLAN, and PsychLit. The bibliographies of located articles were also checked for additional relevant references. Studies meeting the following five inclusion criteria were included in the review: They were investigating the accuracy of self-report among the general population, as opposed to among clinical populations. They employed an adequate and appropriate gold standard. At least 70% of respondents consented to validation, where validation imposed minimal demands on the respondent; and 60% consent to validation was considered acceptable where validation imposed a greater burden. They had a sample size capable of estimating sensitivity and specificity rates with 95% confidence intervals of width +/-10%. The time lag between collection of the self-report and validation data for physical measures did not exceed one month. RESULTS Twenty-four of 66 identified studies met all the inclusion criteria described above. In the vast majority, self-report data consistently underestimated the proportion of individuals considered "at-risk." Similarly, community prevalences of risk factors were considerably higher according to gold standard data sources than they were according to self-report data. CONCLUSIONS This review casts serious doubts on the wisdom of relying exclusively on self-reported health information. It suggests that caution should be exercised both when trying to identify at-risk individuals and when estimating the prevalence of risk factors among the general population. The review also suggests a number of ways in which the accuracy of individuals' self-reported health information can be maximized.
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Affiliation(s)
- S A Newell
- New South Wales Cancer Council Cancer Education Research Program, Wallsend, Australia
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Pearlman DN, Clark MA, Rakowski W, Ehrich B. Screening for breast and cervical cancers: the importance of knowledge and perceived cancer survivability. Women Health 1999; 28:93-112. [PMID: 10378347 DOI: 10.1300/j013v28n04_06] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This study examines the association between recent screening for breast and cervical cancers, knowledge of cancer risk factors, and perceptions of surviving cancer. METHODS Data were from the Cancer Control Supplement to the 1992 National Health Interview Survey (NHIS-CCS). The dependent variable combined breast and cervical cancer screening practices into a single composite index. Two independent variables combined women's knowledge about breast and cervical cancers into single indicators--one representing risk factor knowledge, the other representing perceived likelihood of surviving breast and cervical cancers following early detection. RESULTS Multivariate analysis showed that recency of screening for both breast and cervical cancers was associated with knowledge of cancer risk factors and perceptions of surviving cancer. Education, household income, and smoking status also were correlates of comprehensive screening. Significant interactions between income and perceived survivability, and between education and perceived survivability suggested that the effects of income and education on comprehensive screening varied with perceptions about surviving cancer. CONCLUSION The study suggests that knowledge and attitudinal questions can be combined for two diseases to enhance understanding of who is most likely to be screened comprehensively for breast and cervical cancers. Although national trends show that large percentages of women over age 50 are having mammograms and Pap tests, this progress is not likely to be sustained unless existing barriers are eliminated. Limited knowledge about breast and cervical cancer risk factors and misperceptions about survival from cancer represent two of these barriers.
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Affiliation(s)
- D N Pearlman
- Department of Community Health, Brown University, Providence, RI 02912, USA
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