Competitive testing of health behavior theories: how do benefits, barriers, subjective norm, and intention influence mammography behavior?

Psychological Pathways Through Which Social Norms and Social Identity Influence Eating Behavior: Testing a Conceptual Model

BACKGROUND

Although interventions frequently promote healthy eating, failing to consider psychosocial factors, such as social norms, may limit the effectiveness of these efforts. Perceived social norms are a well-documented determinant of eating behavior; however, there is limited understanding of the processes through which, and for whom, this relationship emerges. Using identity-based motivation as a theoretical framework, we present a conceptual model identifying one route through which descriptive social norms-beliefs about how others behave-predict eating behavior, and test whether this process varies across social identities (e.g., self-perceived weight status).

METHOD

Structured telephone interviews were conducted for a national sample of non-diabetic adults who identified as non-Hispanic White, non-Hispanic Black, or Mexican American (n = 990).

RESULTS

Multigroup SEM analysis comparing individuals who self-identified as overweight (versus "about the right weight" and underweight) demonstrated that perceiving descriptive social norms that people do not eat healthy foods predicted greater perceived barriers to eating healthy foods. Perceived barriers, in turn, predicted stronger beliefs that body weight is uncontrollable, and this relationship was stronger for participants who self-identified as overweight (relative to participants who did not identify as overweight). These beliefs subsequently predicted greater self-reported consumption of unhealthy foods (e.g., sweets), but did not predict consumption of fruits or vegetables.

CONCLUSIONS

This study extends our understanding of a psychosocial process that predicts consumption of unhealthy foods and underscores the importance of social identities for shaping responses to perceived norms.

Understanding the risk perception of visceral leishmaniasis exposure and the acceptability of sandfly protection measures among migrant workers in the lowlands of Northwest Ethiopia: a health belief model perspective

Background

Visceral leishmaniasis (VL) is the leading cause of health concerns among Ethiopian migrant workers. Understanding risk perception and health-protective behavior are significant challenges in the prevention and eradication of the disease. As a result, studies are required to assess these important epidemiological factors, which will provide guidance on how to assist migrant workers in taking preventive measures against VL.

Method

We conducted qualitative research among migrant workers on seasonal agricultural farms in Northwest Ethiopia between June and November 2019 to assess their perception of the risk of contracting VL and their willingness to use protective measures against the disease. Seventeen focus group discussions and 16 key informant interviews were conducted to study migrant workers’ risk perception in relation to sandfly bite exposure and use of sandfly control measures. For analysis, all interviews were recorded, transcribed, and translated. ATLASti was used to perform qualitative content analysis on the data.

Result

Migrant workers are fearful of VL because of previous exposure and the disease’s prevalence in the area. They believe, however, that VL is a minor illness that is easily treated. While Insecticide Treated Nets (ITNs) are widely accepted as a protective measure, there are still reservations about using them due to the seasonality of the transmission, difficulties in hanging them on farm areas, and a preference for alternative traditional practices. Regardless of perceived self-efficacy, the central cues were the message delivered by the health workers and an increase in sandfly bite irritation. Based on the findings, three levels of intervention modalities are suggested: 1) increasing pre-arrival awareness through outdoor media (posters, stickers, billboards), 2) encouraging proper use of protective measures upon arrival at farm camps, and 3) informing departing workers on disease recognition and best practices for health-seeking continuous use of protective measures at home.

Conclusion

This finding suggests that VL prevention interventions should focus on individuals’ perceptions in order to promote consistent use of protective measures. The findings are highly useful in planning effective interventions against VL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13406-3.

Understanding Consumer Stockpiling during the COVID-19 Outbreak through the Theory of Planned Behavior

We use the theory of planned behavior (TPB) to investigate determinants of stockpiling behavior during the COVID-19 lockdown. We analyzed 518 responses to an online survey and used Partial Least Squares Path Modeling (PLS-PM) techniques to estimate relationships between variables. Negative attitude (perceived barriers) and others’ behavior (descriptive social norms) were revealed as significant predictors for both intention to over-purchase and the actual stockpiling behavior. The lack of significance obtained for perceived behavioral control (PBC) is also an important result, strengthening the evidence that factors’ contribution to TPB’s predictive power is strongly context-dependent, respectively that PBC is less relevant in settings dominated by uncertainty. The lack of significance is especially compelling when stockpiling behavior is regarded as deviant conduct from effective consumption. Our findings expand the understanding on the applicability of TPB and offer informed practical suggestions for improving managerial strategies, public and private ones, during extreme events when self-regulation and cognitive control are expedient but hard to achieve.

A path analytic model of health beliefs on the behavioral adoption of breast self-examination

BACKGROUND

In Malaysia, breast cancer accounted for 34.1% of all female cancer cases with women presenting breast cancer at late stages. Breast cancer has a higher five-year survival rate if detected early. An increase of approximately 30% in the five-year survival rate is indicated if breast cancer is detected at stage III compared to stage IV. Thus, survival rate of breast cancer can be increased by creating awareness and encouraging breast cancer screening amongst women. Breast self-examination (BSE) is highly recommended for breast cancer screening due to its simplicity with no incurred cost. The Health Belief Model is used in this study to explain and predict the adoptive behavior of BSE amongst women in Kuantan, Pahang.

MATERIALS AND METHODS

This study employed a multi-stage sampling method using a simple proportion formula at 5% type 1 error, p < 0.05 and absolute error at 2% which resulted in a sample of 520 participants. The data for the study was obtained using a validated bilingual self-constructed questionnaire and the model constructed using Mplus software.

RESULTS

Perceived severity, benefits and barriers were found to significantly influence the behavioral adoption of BSE. Married women aged from 45 to 55 years and knowledge were found to significantly moderate the relationship between perceived benefits and behavioral adoption of BSE. Further, self-efficacy was found as the core construct that mediates the relationship between married women aged 45 to 55 years and the behavioral adoption of BSE.

CONCLUSION

Self-efficacy is found in the study to influence the behavioral adoption of BSE. This is undeniable as self-efficacy can promote confidence in initiating and maintenance of behavioral change if the perceived change is beneficial at an acceptable cost.

Older Women’s Perspectives Driving Mammography Screening Use and Overuse: a Narrative Review of Mixed-Methods Studies

Purpose of Review

Examining what older women know and perceive about mammography screening is critical for understanding patterns of under- and overuse, and concordance with screening mammography guidelines in the USA. This narrative review synthesizes qualitative and quantitative evidence around older women’s perspectives toward mammography screening.

Recent Findings

The majority of 43 identified studies focused on promoting mammography screening in women of different ages, with only four studies focusing on the overuse of mammography in women ≥ 70 years old. Older women hold positive attitudes around screening, perceive breast cancer as serious, believe the benefits outweigh the barriers, and are worried about undergoing treatment if diagnosed. Older women have limited knowledge of screening guidelines and potential harms of screening.

Summary

Efforts to address inequities in mammography access and underuse need to be supplemented by epidemiologic and interventional studies using mixed-methods approaches to improve awareness of benefits and harms of mammography screening in older racially and ethnically diverse women. As uncertainty around how best to approach mammography screening in older women remains, understanding women’s perspectives along with healthcare provider and system-level factors is critical for ensuring appropriate and equitable mammography screening use in older women.

Comparison of competitive cognitive models in explanation of women breast cancer screening behaviours using structural equation modelling: Health belief model and theory of reasoned action

INTRODUCTION

The efficacy of the theory of reasoned action (TRA), compared with the health belief model (HBM), has not been fully elucidated in screening practices.

METHODS

This population-based cross-sectional study was conducted with samples of 500 women aged 35-85 years, in the north of Iran. The data of demographic characteristics, awareness, health belief, subjective norms and screening behaviours were collected using standard instruments. Structural equation modelling (SEM) was applied to estimate the pathways of regression coefficients.

RESULTS

The model that incorporated the health belief and the standardised coefficient of the knowledge scores influenced significantly on the health belief perception (beta = 0.375), and consequently, the health belief directly affected screening behaviours (beta = 0.73). In contrast, In TRA model, while the direct effect of knowledge on intention was negligible it has a greater indirect effect by mediating health belief and subjective norms (indirect beta = 0.35) on behaviour intention. A high coefficient of intention was observed by subjective norms (beta = 0.626), and the intention has a great positive effect on screening behaviour (beta = 0.601). All fitting indexes were quietly improved in the TRA model as compared with HBM.

CONCLUSION

Thus, the unifying structure of knowledge, health belief, subjective norms and intention improves the predictor power in breast cancer screening behaviours.

An application of the theory of planned behaviour to understand compliance with daytime running headlights law among motorcycle riders

Fatal motorcycle crashes are a persistent problem in Southeast Asia. In many respects, road safety experts have acknowledged conspicuity issue as one of the main causes of such accidents. To mitigate this deficiency, daytime running headlights (DRHs) law has been documented among the widely exercised countermeasures. The present study aimed to explore socio-psychological factors shaping intentions towards use of DRHs among Malaysian motorcyclists, because compliance level with this rule has remained constant since 1996 (80%). For this purpose, a model was constructed through the Theory of Planned Behaviour (TPB) to evaluate factors affecting motorcyclists' intentions towards compliance with DRHs law. A series of statistical analyses were performed to explain the effect of these factors and to predict degree of compliance with this rule. The model applied on a sample of university students (N = 398) demonstrated that the TPB components could significantly predict motorcycle riders' behaviours and degree of compliance with DRHs law. Moreover, it would be of assistance to policy-makers to recognize groups of motorcyclists more likely to cause an increase in traffic accidents. In general, regular educational campaigns were recommended to raise awareness regarding consequences of not using DRHs and also to nurture factors influencing motorcyclists' attitudes towards DRHs.

Assessing the mediating role of breast conflict on cognitive factors associated with adopting mammography

Breast conflict may represent a woman's unpleasant feelings toward her breasts, which may adversely affect her decision to undertake the procedures for an early detection of breast cancer. The purpose of the present study was to examine the mediating role of breast conflict in cognitive factors, as suggested by the Health Belief Model (HBM), for adopting mammography. In this explanatory cross-sectional study, multistage cluster sampling was employed to recruit 738 women in the age range of 40 to 69 years in Iran. Champion's revised HBM Scale for mammography adoption and the Women's Breast Conflict Scale were used to measure the variables of interest. Generalized structural equation modeling and hierarchical logistic regression were used for data analysis. Breast conflict was negatively associated with perceived barriers of mammography. Perceived barriers were inversely related to self-efficacy, which was positively related to mammography, suggesting the mediating role of perceived barriers and self-efficacy, connecting breast conflict to mammography indirectly. The mediating role of breast conflict in perceived barriers and self-efficacy suggests an indirect link between breast conflict and mammography. Clinicians and public health-care providers must pay attention to women's feelings in formulating and delivering appropriate interventions and consultations.

Socio-Cognitive Determinants of the Mammography Screening Uptake among Iranian Women

Background: Mammography screening uptake is the most effective method in breast cancer screening. The aim of this study was to determine the determinants related to mammography screening uptake among Iranian women based on the theory of planned behavior. Materials and Methods: This cross-sectional study was conducted among 408 women who referred to health centers in Kermanshah city, the western of Iran, during 2016. Participants filled out a self-administered questionnaire. Data were analyzed by SPSS version 21 using Pearson correlation, linear and logistic regression statistical tests at 95% significant level. Results: The mean age of participants was 39.61 years [SD: 8.28], ranged from 30 to 60 years. Almost 13% of the participants had already mammography screening uptake at least once. Perceived behavioral control (OR=1.229) and behavioral intention (OR=1.283) were the more influential predictors on mammography screening uptake. Conclusions: Based on result, it seems increase perceived behavior control toward mammography screening uptake may be usefulness in promotion of mammography screening uptake among Iranian women.

An Evidence Map of the Women Veterans' Health Research Literature (2008-2015)

BACKGROUND

Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning.

METHODS

The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps.

RESULTS

We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials.

CONCLUSIONS

Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.

Promoting early presentation of breast cancer in older women: sustained effect of an intervention to promote breast cancer awareness in routine clinical practice

Background

Older women have poorer survival from breast cancer, which may be at least partly due to poor breast cancer awareness leading to delayed presentation and more advanced stage at diagnosis. In a randomised trial, an intervention to promote early presentation of breast cancer in older women increased breast cancer awareness at 1 year compared with usual care (24 versus 4%). We examined its effectiveness in routine clinical practice.

Methods

We piloted the intervention delivered by practising health professionals to women aged about 70 in four breast screening services. We measured the effect on breast cancer awareness at 1 year compared with comparison services, where women did not receive the intervention.

Results

At 1 year, 25% of women in pilot services were breast cancer aware compared with 4% in comparison services (p = 0.001). The components of breast cancer awareness were knowledge of breast cancer non-lump symptoms (pilot: 63% vs comparison: 82% at 1 year; OR = 2.56, 95% CI 1.92-3.42), knowledge of age related risk (pilot: 8% vs comparison: 36% at 1 year; OR = 5.56, 95% CI 4.0-7.74) and reported breast checking (pilot: 70% vs comparison: 78% at 1 year; OR = 1.49, 95% CI 1.13-1.96).

Conclusion

The intervention may be as effective in routine clinical practice as in a randomised controlled trial. This intervention has the potential to reduce patient delay in the diagnosis of breast cancer in older women.

Trial registration

The PEP trial was registered with the International Standard Registered Clinical/soCial sTudy Number (ISRCTN) as a clinical trial (ISRCTN31994827) on 3rd October 2007.

Testing whether barriers to a hypothetical screening test affect unrelated perceived benefits and vice versa: A randomised, experimental study

OBJECTIVE

Determine whether (fictitious) health screening test benefits affect perceptions of (unrelated) barriers, and barriers affect perceptions of benefits.

METHODS

UK adults were recruited via an online survey panel and randomised to receive a vignette describing a hypothetical screening test with either high or low benefits (higher vs. lower mortality reduction) and high or low barriers (severe vs. mild side-effects; a 2×2 factorial design). ANOVAs compared mean perceived benefits and barriers scores. Screening 'intentions' were compared using Pearson's χ² test.

RESULTS

Benefits were rated less favourably when barriers were high (mean: 27.4, standard deviation: 5.3) than when they were low (M: 28.5, SD: 4.8; p=0.010, partial η²=0.031). Barriers were rated more negatively when benefits were low (M: 17.1, SD: 7.6) than when they were high (M: 15.7, SD: 7.3; p=0.023, partial η²=0.024). Most intended to have the test in all conditions (73-81%); except for the low benefit-high barrier condition (37%; p<0.0005; N=218).

CONCLUSIONS

Perceptions of test attributes may be influenced by unrelated characteristics.

PRACTICE IMPLICATIONS

Reducing screening test barriers alone may have suboptimal effects on perceptions of barriers if benefits remain low; increasing screening benefits may not improve perceptions of benefits if barriers remain high.

Ethnic differences in social support after initial receipt of an abnormal mammogram

OBJECTIVES

We examine access to and type of social support after initial receipt of an abnormal mammogram across non-Latina White (NLW), African American, and Latina women.

METHOD

This cross-sectional study used a mixed method design, with quantitative and qualitative measures. Women were recruited through 2 community advocates and 3 breast-health-related care organizations.

RESULTS

With regard to access, African American women were less likely to access social support relative to NLW counterparts. Similar nonsignificant differences were found for Latinas. Women did not discuss results with family and friends to avoid burdening social networks and negative reactions. Networks' geographic constraints and medical mistrust influenced Latina and African American women's decisions to discuss results. With regard to type of social support, women reported emotional support across ethnicity. Latina and African American women reported more instrumental support, whereas NLW women reported more informational support in the context of their well-being.

CONCLUSIONS

There are shared and culturally unique aspects of women's experiences with social support after initially receiving an abnormal mammogram. Latina and African American women may particularly benefit from informational support from health care professionals. Communitywide efforts to mitigate mistrust and encourage active communication about cancer may improve ethnic disparities in emotional well-being and diagnostic resolution during initial receipt of an abnormal mammogram. (PsycINFO Database Record

The Influence of Spiritual Framing on African American Women's Mammography Intentions: A Randomized Trial

Spiritual framing of breast cancer communication may provide a useful strategy for addressing disparate rates of breast cancer mortality among African American women. The efficacy of a spiritually framed breast cancer screening (BCS) message was compared with that of a traditional BCS message. Specifically, 200 African American women were randomly assigned to review either a spiritually framed or traditional BCS message and complete a self-administered survey, including a thought-listing form. Message efficacy was measured by number of thoughts generated (elaboration), ratio of positive to negative thoughts (polarity), and intention to obtain and/or recommend a mammogram. Multiple linear regression and structural equation modeling were used to assess direct and indirect (mediated) associations among variables. Spiritual framing was positively associated with greater elaboration (β = .265, SE = .36, p < .001) and more positive polarity (β = .237, SE = .04, p < .001) . Spiritual framing also had a significant indirect effect on mammography intentions through polarity (standardized indirect effect = .057, 95% confidence interval [.024, .106], p < .001). These results indicate that spiritual framing may improve the efficacy of BCS messages among African American women by eliciting more positive thoughts about screening. Interventions targeting African American women might consider the role of spirituality when tailoring messages to encourage regular mammography use.

Determinants of mammography screening participation among Turkish immigrant women in Germany--a qualitative study reflecting key informants' and women's perspectives

Mammography screening programmes aiming to reduce mortality from breast cancer are implemented in most European countries. Immigrant women are less likely to participate than women of the respective autochthonous populations in several European countries but not in Germany. Qualitative, semi-structured interviews were conducted with 16 key informants and 10 Turkish immigrant women aged 50-69 years to analyse the factors influencing their screening participation in Germany. Interviews were analysed using summarising content analysis. The Theory of Planned Behaviour was used for structuring the results. Key informants stated poor German language skills and insufficient knowledge about breast cancer and screening as factors influencing screening participation. Immigrant women demonstrated basic knowledge about screening, but their attitudes towards screening varied. Information from the invitation letter of the screening programme was often filtered by family members. Key informants tended to emphasise barriers and system-related factors while the Turkish women focused more on factors on the individual level. Contrasting both perspectives is helpful for health professionals to critically assess their own views. Measures to improve screening participation need to address not only barriers but also take women's attitudes and norms into account, thus helping women to make an informed decision.

Uptake of breast screening and associated factors among Hong Kong women aged ≥50 years: a population-based survey

OBJECTIVE

To examine the uptake of breast screening and its associated factors among Hong Kong Chinese women aged ≥50 years.

STUDY DESIGN

Cross-sectional population-based survey.

METHODS

A sample of Hong Kong Chinese women was recruited through telephone random-digit dialling. The survey consisted of six sections: perceived health status, use of complementary medicine, uptake of breast screening, perceived susceptibility to cancer, family history of cancer and demographic data. The factors associated with uptake of breast screening were analysed using logistic regression analysis.

RESULTS

In total, 1002 women completed the (anonymous) telephone survey. The mean age was 63.5 (standard deviation 10.6) years. The uptake rate of breast screening among Hong Kong Chinese women aged ≥50 years was 34%. The primary reasons for undertaking breast screening were as part of a regular medical check-up (74%), prompted by local signs and symptoms (11%) and a physician's recommendation (7%). Higher educational level, married or cohabiting, family history of cancer, frequent use of complementary therapies, regular visits to a doctor or Chinese herbalist, and the recommendation of a health professional were all independently and significantly associated with increased odds of having had a mammogram.

CONCLUSIONS

This study provides community-based evidence of the need for public health policy to promote broader use of mammography services among this target population, with emphasis on the active involvement of health care professionals, through the development and implementation of appropriate evidence-based and resource-sensitive strategies.

Physician and Family Recommendations to Obtain a Mammogram and Mammography Intentions: The Moderating Effects of Perceived Seriousness and Risk of Breast Cancer

A growing body of literature has demonstrated psychosocial factors enable mammography intentions and usage among Latinas. Although these factors (e.g., family recommendations, breast cancer perceptions) likely influence one another, little research has examined interactive effects. The current study assessed the moderating effect of perceived breast cancer seriousness and risk on associations between recommendations to obtain mammography and mammography intentions. This sample included 97 Latinas in rural Eastern Washington State. After adjusting for age, two significant interactions emerged: perceived seriousness × physician recommendation and perceived risk × family recommendation. This exploratory study provides important directions for future communication research and planning to improve screening disparities.

Longitudinal predictors of colorectal cancer screening among participants in a randomized controlled trial

OBJECTIVE

Few studies use longitudinal data to identify predictors of colorectal cancer screening (CRCS). We examined predictors of (1) initial CRCS during the first year of a randomized trial, and (2) repeat CRCS during the second year of the trial among those that completed FOBT in Year 1.

METHODS

The sample comprised 1247 participants of the Systems of Support to Increase Colorectal Cancer Screening (SOS) Trial (Group Health Cooperative, August 2008 to November 2011). Potential predictors of CRCS were identified with logistic regression and included sociodemographics, health history, and validated scales of psychosocial constructs.

RESULTS

Prior CRCS (OR 2.64, 95% CI 1.99-3.52) and intervention group (Automated: OR 2.06 95% CI 1.43-2.95; Assisted: OR 4.03, 95% CI 2.69-6.03; Navigated: OR 5.64, 95% CI 3.74-8.49) were predictors of CRCS completion at Year 1. For repeat CRCS at Year 2, prior CRCS at baseline (OR 1.97, 95% CI 1.25-3.11), intervention group (Automated: OR 9.27, 95% CI 4.56-18.82; Assisted: OR 11.17, 95% CI 5.44-22.94; Navigated: OR 13.10, 95% CI 6.33-27.08), and self-efficacy (OR 1.32, 95% CI 1.00-1.73) were significant predictors.

CONCLUSION

Self-efficacy and prior CRCS are important predictors of future screening behavior. CRCS completion increased when access barriers were removed through interventions.