Breast cancer: The intention to have a mammography and a clinical breast examination - application of the theory of planned behavior

Attitude sustains longer than subjective norm and perceived behavioral control: Results of breast cancer screening educational intervention

Breast malignancy is the most frequent carcinoma among females across the world and third-most in Nepal. Early diagnosis of breast cancer through breast health awareness and self-examination, in addition to mammography screening, is a highly feasible and useful technique in poorly resourced settings. However, their intentions, whether to modify behaviors or actions, remain debatable and less explained in the literature. So, we aimed to assess how long an educational intervention affects women's intention to do a breast self-examination (BSE) and mammography screening. After assessing feasibility, one ward was assigned to the intervention (IG; ward number 30) and control group (CG; ward number 33), and then with inclusion criteria, a total of 360 females (180 each in IG and CG) aged 40-75 years enrolled in the study. After the baseline assessment, participants in the IG were delivered an hour-long breast cancer screening-related lecture-discussion- demonstration session that included BSE and mammography, aided with a silicone dummy. The session was carried out by the female trained nurses. Outcome data were obtained at the baseline, 4, 8, and 12 months following the intervention. Attitudes, perceived behavioral controls (PBCs) and behavioral intents (BIs) of both mammography and BSE at baseline were similar in both IG and CG except in case of subjective norms (SNs). Intents of BSE remained effective for 4 months, whereas for mammography, it was effective only at 4 and 12 months. Moreover, attitudes toward both tests remained intact for 4, 8, and 12 months (p = < .05) consistently. With regards to PBCs, women having good control remained only for 4 months in both screening tests. Further, regarding SN, significant mean changes were observed at 4 and 12 months in BSE, and only at 4 months in mammography screening. The session was effective in sustaining BSE and mammography intentions for at least 4 months. To retain the effects longer (up to 12 months), additional educational strategies focusing on subjective norms and perceived behavioral controls of both tests are highly warranted.

Effect of Educational Intervention Based on Theory of Planned Behavior (TPB) on Doing Breast Self-examination in a Sample of Iranian Women

Background

Breast self-examination (BSE) is an important part of health care for all women in every stage of life. This study aimed to investigate the effect of theory of planned behavior (TPB) on doing BSE in a sample of Iranian women.

Methods

A cross-sectional study was carried out to examine the factors affecting the BSE in 400 women. Then, a quasi-experimental study was conducted on 200 subjects (100 in experimental group and 100 in control group). The educational intervention for the experimental group consisted of 8 training sessions. A questionnaire including demographic characteristics, knowledge, and constructs of TPB was used to measure BSE performance before and 6 months after the intervention. Constructs of attitude, subjective norms, and perceived behavioral control predicted the intention to do the BSE.

Results

The mean age of the subjects was 31.65 ± 7.59 years. The studied variables predicted 38.7% of behavioral intention (P < .001, odds ratio = 0.387). Six months after the intervention, the experimental group showed a significant increase in the knowledge, attitude, perceived behavioral control, subjective norms, intention, and BSE performance compared with the control group (P < .001).

Conclusions

This study showed that educational intervention based on the TPB was effective in promoting breast cancer screening behavior such as BSE. Therefore, it is suggested that health educators and health care planners use educational texts based on these constructs of TPB to increase their influence on individuals via screening behavior for breast cancer.

‘Exploring the Influence of Social Media Influencers on Intention to Attend Cervical Screening in the UK: Utilising the Theory of Planned Behaviour’

Objectives

Cervical cancer is 99.8% preventable when detected early; however, uptake of screening in the United Kingdom is at a 20-year low. Recently, a number of social media influencers have video logged about their experiences of cervical screening through narrative communication with their audience. Here we aimed to explore if accessing cervical screening information from a social media influencer can impact the theory of planned behaviour variables and predict intention to attend cervical screening appointments.

Design

Utilising a cross-sectional design a volunteer sample of 102 UK women (mean age = 28; SD = 3.10; range = 25–35) took part in an online questionnaire study.

Results

Hierarchical regression modelling revealed attitude as a significant predictor of intention to attend a cervical screening appointment and that social media influencers affect attitudes of their audience, indirectly influencing intention to attend.

Conclusion

Health messages communicated by social media influencers are effective in promoting positive attitudes but not directly influence intention to attend towards cervical screening. Further research should explore influencer impact on attitudes towards this health behaviour with the ultimate aim of increasing attendance and consequently saving lives.

Tendency to Breast Cancer Screening Among Rural Women in Southern Iran: A Structural Equation Modeling (SEM) Analysis of Theory of Planned Behavior

Background:

Early detection of breast cancer is a crucial factor in surviving the disease. This study aimed to investigate the mammography screening based on the theory of planned behavior (TPB) among rural women in Fasa and Shiraz cities, Iran.

Methods:

This study is a cross-sectional study performed on 800 female clients referring to rural health centers in Fasa and Shiraz cities in southern Iran in early 2021. The authors decided to send and distribute the electronic questionnaire form through the WhatsApp application in collaboration with the health staff of rural health centers for the people covered by these centers. Data gathering tools were a questionnaire on demographic characteristics, a questionnaire based on constructs of TPB, and behavior of mammography screening. Using the structural equation model (SEM), the TPB constructs and demographic variables were entered into the model. Data analysis was executed employing SPSS software version 26 and Amos version 24 (IBM Co., Ann Arbor, MI, USA). Analyzing the data was carried out using the 1-way analysis of variance (ANOVA), logistic regression, and structural equation analysis. During data analysis, various model indicators such as the goodness of fit, including comparative fit index (CFI), goodness-of-fit index (GFI), root mean square error of approximation (RMSEA), and chi-square index/df were evaluated. The significance level in all tests was considered 0.05.

Results:

The knowledge, attitude, and perceived behavioral control were the predictors of intention and behavior of mammography screening among the women. Among demographic variables, age, literacy, being menopausal, cancer in family, city, and ethnicity contribute more to the variance variation in TPB constructs. In this study, 7.2% of Persians, 8% of Qashqai Turks, and 4.5% of Arabs are contemplating going to mammography screening. In total, 6.8% (54 people) of all individuals intended to go mammography screening, and 5.4% (43 people) had a history of mammography screening. Goodness-of-fit indices (χ² = 18.45, df = 10, n = 800, χ²/df = 1.845, RMSEA = 0.032, GFI = 0.90, non-normed fit index (NNFI) = 0.91) of conceptual model of this study indicate the suitability of the model.

Conclusions:

The results of the study indicated that the constructs of the TPB can predict mammography screening behaviors in rural women. It has also demonstrated that mammographic behavior can be improved in rural women using education based on the TPB model, emphasizing critical psychological factors of creating or changing behavior.

Evaluating the Feasibility of Continuing Medical Education for Disseminating Emerging Science on the Breast Cancer and Environment Connection

Developing continuing medical education (CME) training programs is a strategy for communicating emerging science to health practitioners. This research tests the feasibility of using CME modules for translating and disseminating research findings from the Breast Cancer and Environment Research Program. Recent findings have identified certain windows of susceptibility, like during puberty, in which exposure to endocrine-disrupting chemicals can increase breast cancer risk later in life. In order to reach pediatric patients and their caregivers, using a Diffusion of Innovations framework, pediatric health-care providers were identified as opinion leaders. Two CME modules informed by theory and formative research were tested with a sample of pediatricians and pediatric nurse practitioners. Participants completed knowledge, attitude, intention, and behavior items immediately before and after exposure to a randomly assigned module, and then again 3 weeks later. Quantitative and qualitative results indicate knowledge gain and strong links between practitioners' intentions to enact and implemented behavior learned from training recommendations with parents and caregivers in their practices. Results indicate that CMEs can be an effective strategy for translational activities targeted to health providers in order to change behavior within practice.

Factors associated with breast cancer screening intention in Kathmandu Valley, Nepal

Background

Breast cancer burden is increasing in low-income countries (LICs). Increasing incidence and delayed presentation of breast cancer are mainly responsible for this burden. Many women do not participate in breast cancer screening despite its effectiveness. Moreover, studies are limited on the barriers associated with low utilization of breast cancer screening in LICs. This study identified breast cancer screening behavior and factors associated with breast cancer screening intention among women in Kathmandu Valley, Nepal.

Methods

A cross-sectional study was conducted among 500 women living in five municipalities of Kathmandu Valley, Nepal. Data were collected from July to September 2018, using a structured questionnaire. Interviews were conducted among women selected through proportionate random household sampling. This study was conceptualized using the theory of planned behavior, fatalism, perceived susceptibility, and perceived severity. The outcome variables included: the intention to have mammography (MMG) biennially, the intention to have clinical breast examination (CBE) annually, and the intention to perform breast self-examination (BSE) monthly. Analysis was conducted separately for each outcome variable using partial proportional odds model.

Results

Out of 500 women, 3.4% had undergone MMG biennially, 7.2% CBE annually, and 14.4% BSE monthly. Women with a positive attitude, high subjective norms, and high perceived behavioral control were more likely to have the intention to undergo all three screening methods. Similarly, women were more likely to have intention to undergo CBE and MMG when they perceived themselves susceptible to breast cancer. Conversely, women were less likely to have intention to undergo CBE when they had high fatalistic beliefs towards breast cancer.

Conclusion

Women in this study had poor screening behavior. The practice of breast self-examination was comparatively higher than clinical breast examination and mammography. Multidimensional culturally sensitive interventions are needed to enhance screening intentions. Efforts should be directed to improve attitude, family support, and fatalistic belief towards cancer. Furthermore, the proper availability of screening methods should be ensured while encouraging women to screen before the appearance of symptoms.

Psychographic predictors of intention to use cervical cancer screening services among women attending maternal and child health services in Southern Ethiopia: the theory of planned behavior (TPB) perspective

Background

Detection of the premalignant forms cervical cancer through screening in the target age group is one of the effective strategies in the prevention of the disease. Nevertheless, the cervical cancer screening service use remains considerably low in Ethiopia. Indeed; promoting screening behaviors requires understanding the factors influencing women’s motivation towards the service. Our study has explored the psycho-graphic factors associated to intention to use cervical cancer screening among women visiting maternal and child health services in Southern Ethiopia, 2017.

Methods

Institution based cross-sectional study was used employing 422 women’s age between 30 and 49 years old. A structured questionnaire was used to collect data on interviewer-administered basis. All assumptions of theory of planned behavior (TPB) were considered to measure intention, attitude, perceived social pressure and perceived ability to control circumstances against cervical cancer screening. Data were analyzed using statistical package for social sciences version 21.0. Multiple linear regression models were conducted to identify factors associated to intention to use cervical cancer screening. P-value less than 5% was considered to indicate significant association.

Result

Four hundred and two (95%) of the respondents completed the interview. Knowledge of the disease signs, symptoms, risk factors and prevention methods was 162(41.4%). Knowledge about the disease and past screening experience were positively associated with intention to use cervical cancer screening (β = 0.145, 95% CI = [0.047, 0.170]) and (β = 0.098, 95% CI = [0.093, 1.001]) respectively. Further; standardized regression coefficient showed that all dimensions of TPB were positively associated to intention to use the services with perceived behavioral control (β = 0.297, 95% CI = [0.172, 0.343]), perceived social pressure (β = 0.248, 95% CI = [0.131, 0.301]) and attitude towards screening (β = 0.110, CI = [0.018, 0.158]).

Conclusion

Overall; the intention to use cervical cancer screening was a function of attitude, perceived social pressure and perceived behavioral control confirming the hypothesis of the study. None of the socio-demographic variables were associated to intention. Health behavior change interventions should focus on increasing knowledge and empowering women that enable them to evaluate their control beliefs and develop ability against social norms and circumstances that compete with the use of cervical cancer screening services.

The Effect of Education Based on the Theory of Planned Behavior on Iron Supplementation among Pregnant Women

Background

Iron is an essential element for women of reproductive age, especially in the period before and during the pregnancy. This study investigates the consumption of iron to prevent iron deficiency anemia among pregnant women visiting Neyshabur healthcare centers based on the theory of planned behavior.

Methods

In this experimental study, data were collected through a questionnaire survey. It included 160 pregnant women who were receiving maternity services at twelve healthcare centers in the city of Neyshabur in Iran between 2015 and 2017. The participants’ demographic and anthropometric characteristics, Using the theory of planned behavior, and blood lab examination results, including ferritin levels were measured and the data were analyzed using IBM SPSS ver. 22.0 (IBM Corp., Armonk, NY, USA).

Results

The average scores of knowledge, attitude, perceived behavioral control, subjective norms, and intention categories for the intervention group were meaningfully increased after the participants received education on iron supplementation (P<0.05). However, these changes were not found to be significant in the control group (P>0.05). No statistically significant difference was obtained in the subjective norms category between the two groups after the education intervention (P=0.92).

Conclusion

Based on the experimental effects of education encouraging iron supplementation in pregnant women, it is suggested that workshops promoting iron supplementation should be conducted in health centers with the aim of preventing widespread iron deficiency anemia.

Health Behavioural Theories and Their Application to Women's Participation in Mammography Screening

The most effective method of detecting breast cancer among asymptomatic women is by mammography screening. Most countries have this preventive measure in place for women within their society; however, most of these programs struggle with attendance. This article discusses four health behavioural theories and models in relation to mammography screening that may explain the factors affecting women's participation, including the health belief model, theory of planned behaviour, trans-theoretical model, and the theory of care seeking behaviour. In summary, analysis of these theories indicates that the theory of care seeking behaviour has value for exploring these factors because of its sensitivity to socioeconomic differences that exist among women in society and because it has a broader construct (such as habit and external factors) compared to the other health behavioural theories.

Exploring breast health practices of post-menopausal women: Implications to informed consent

In light of the contention surrounding breast health practices, the research aimed to explore post-menopausal women's experiences of such practices. Semi-structured interviews were conducted in July and August 2015 with 13 Australian women aged 54-74 years. Data were analysed thematically. Participants deemed their engagement with breast health practices as the 'right' thing. However, engaging in these 'right' practices appeared to be fostered by misconceptions. The findings suggest that women may not be making evidence-informed decisions to engage in breast screening; identify contemporary barriers to promoting informed decisions; and may inform information pertinent to breast screening policy, campaigns and decision aid designs.

Old Clothes and an Older Look

Social cognition models (SCMs) have been described by Ingham as old clothes fit only for the jumble, yet their use in investigations of health behaviour performance in recent years has proliferated rather than declined. In a critique of the literature, this paper highlights a range of theoretical, methodological and performance-based limitations of the SCM approach and demonstrates that a ceiling has now been reached whereby more than half the variance in health behaviour performance is routinely unexplained, despite all efforts to improve the models. A major conceptual flaw within the SCM approach is identified and it is argued that `health behaviours', as generally defined, do not exist and that health-related activities only acquire meaning and significance on the basis of their relationship to the broader social prac- tices of which they form a part. A `new look' is proposed for research in this field which takes this alternative conceptualization into account.

Mediators of repeat mammography in two tailored interventions for Iranian women

Background

Many theory-based interventions exist that incorporate theoretical constructs (e.g., self-efficacy, behavioral control) believed to increase the likelihood of mammography. Nonetheless, little work to date has examined if increased screening among women receiving such interventions occurs due to changes in these targeted constructs. The aim of this study is to address this gap in the literature in the context of two interventions for improving regular screening among Iranian women.

Methods

A sample of 176 women over 50 years old in Tehran, Iran were randomly allocated into one of these three conditions: 1) an intervention based on Health Belief Model (HBM); 2) an intervention based on an integration of the HBM and selected constructs from the TPB (TPB); and 3) a control group (CON). Questionnaires were administered before the intervention and after a 6-month follow-up. The Preacher and Hayes method of mediation was used in analytic models.

Results

Changes in susceptibility, self-efficacy, and perceived control appeared to mediate HBM-CON differences in screening. Barriers attenuated the mediating effect of self-efficacy. Changes in barriers and self-efficacy appeared to mediate TPB-CON differences in screening.

Conclusion

This study was successful in identifying which theory-based constructs appear to underlie the effectiveness of HBM- and TPB-based interventions. Specific constructs have been identified that should be targeted in clinical practice to increase mammography practices among Iranian women.

Facilitator psychological constructs for mammography screening among Iranian women

BACKGROUND

While many researchers often use a theoretical framework for mammogram repeat interventions, it seems they do not apply an identified mediation analysis method. The aim of this study was to determine the mediators of mammogram replication behavior in two tailored interventions for non-adherent Iranian women.

MATERIALS AND METHODS

A sample population of 184 women over 50 years old in Sanandaj, Iran, was selected for an experiment. Participants were randomly allocated into one of the three conditions: 1) an intervention based on the Health Belief Model (HBM) 2) an intervention based on an integration of the HBM and selected constructs from the Theory of Planned Behavior (TPB), and 3) a control group. Constructs were measured before the intervention, and after a 6-month follow-up.

RESULTS

Perceived self-efficacy, behavioral control, and subjective norms were recognized as mediators in the HBM and selected constructs from the TPB intervention. Perceived susceptibility, severity, barriers, self-efficacy and behavioral control met the criteria for mediation in the HBM intervention.

CONCLUSIONS

This study was successful in establishing mediation in a sample of women. Our findings enrich the literature on mammography repeat, indicating key intervention factors, and relegating redundant ones in the Iranian populations. The use of strategies to increase mammography repeat, such HBM and TPB constructs is suggested to be important for maintaining a screening behavior, once the behavior has been adopted.

Using the Theory of Planned Behavior to Understand Cervical Cancer Screening Among Latinas

To reduce the high incidence of cervical cancer among Latinas in the United States it is important to understand factors that predict screening behavior. The aim of this study was to test the utility of theory of planned behavior in predicting cervical cancer screening among a group of Latinas. A sample of Latinas (N = 614) completed a baseline survey about Pap test attitudes subjective norms, perceived behavioral control, and intention to be screened for cervical cancer. At 6 months postbaseline, cervical cancer screening behavior was assessed. Structural equation modeling was used to test the theory. Model fit statistics indicated good model fit: χ(2)(48) = 54.32, p = .246; comparative fit index = .992; root mean square error of approximation = .015; weighted root mean square residual = .687. Subjective norms (p = .005) and perceived behavioral control (p < .0001) were positively associated with intention to be screened for cervical cancer, and the intention to be screened predicted actual cervical cancer screening (p < .0001). The proportion of variance (R2) in intention accounted for by the predictors was .276 and the R2 in cervical cancer screening accounted for was .130. This study provides support for the use of the theory of planned behavior in predicting cervical cancer screening among Latinas. This knowledge can be used to inform the development of a theory of planned behavior-based intervention to increase cervical cancer screening among Latinas and reduce the high incidence of cervical cancer in this group of women.

How well do the theory of reasoned action and theory of planned behaviour predict intentions and attendance at screening programmes? A meta-analysis

Meta-analysis was used to quantify how well the Theories of Reasoned Action and Planned Behaviour have predicted intentions to attend screening programmes and actual attendance behaviour. Systematic literature searches identified 33 studies that were included in the review. Across the studies as a whole, attitudes had a large-sized relationship with intention, while subjective norms and perceived behavioural control (PBC) possessed medium-sized relationships with intention. Intention had a medium-sized relationship with attendance, whereas the PBC-attendance relationship was small sized. Due to heterogeneity in results between studies, moderator analyses were conducted. The moderator variables were (a) type of screening test, (b) location of recruitment, (c) screening cost and (d) invitation to screen. All moderators affected theory of planned behaviour relationships. Suggestions for future research emerging from these results include targeting attitudes to promote intention to screen, a greater use of implementation intentions in screening information and examining the credibility of different screening providers.

Predictors of regular mammography use among American Indian women in Oklahoma: a cross-sectional study

Background

There are significant disparities in breast cancer screening and survivorship between American Indian (AI) and non-Hispanic white women. This study aimed to identify the salient beliefs AI women from Oklahoma have on regular mammography screening, and to determine which beliefs and health- related practices are associated with past mammography screening behavior.

Methods

This study used an integrated model of the Theory of Planned Behavior as the guiding theoretical framework. Data were collected from 255 (mean age = 51 years, SD 7.64 years) AI women randomly selected from a rural Oklahoma medical clinic (response rate: 79%). Multivariate logistic regression was used to identify factors associated with self-reported past mammography within the last two years while controlling for demographic variables. Associations were summarized using odds ratios (OR), the ratio of the odds of past mammography per a 1-unit increase in continuous independent factor scales (subjective physician norm, cultural affiliation, fatalism, knowledge of mammography screening guidelines, and perceived behavior control barriers) or between groups defined by categorical variables, and 95% confidence intervals (CI).

Results

Of the participants, 65% (n = 167) reported a screening mammogram within the last two years. After adjustment for age and educational status, women with a higher total subjective-norm physician score (OR = 1.15, 95% CI: 1.06-1.24), a higher knowledge of mammography screening guidelines (OR = 1.52, 95% CI: 1.00-2.31), a family history of breast cancer (OR = 9.97, 95% CI: 3.05-32.62), or reporting an annual versus none or a single physician breast examination (OR = 5.57, 95% CI: 1.79-17.37) had a higher odds of past mammography. On the other hand, women who were more culturally affiliated (OR = 0.42, 95% CI: 0.24-0.74), perceived more barriers (OR = 0.86, 0.78-0.94), or had higher fatalistic attitudes toward breast cancer (OR = 0.90, 95% CI: 0.82-0.99) had lower odds of past mammography.

Conclusion

In the development of culturally-appropriate interventions promoting mammography among AI communities, emphasis could be put on the following: a) promoting clinic-related practices (e.g. physician recommendation, physician breast examination); b) promoting community-related practices (e.g. knowledge about mammography while eliminating fatalistic attitudes); and c) reducing environmental barriers.

Study protocol for "Moving Bright, Eating Smart"- A phase 2 clinical trial on the acceptability and feasibility of a diet and physical activity intervention to prevent recurrence in colorectal cancer survivors

Background

Colorectal cancer is the second most common cancer and cancer-killer in Hong Kong with an alarming increasing incidence in recent years. The latest World Cancer Research Fund report concluded that foods low in fibre, and high in red and processed meat cause colorectal cancer whereas physical activity protects against colon cancer. Yet, the influence of these lifestyle factors on cancer outcome is largely unknown even though cancer survivors are eager for lifestyle modifications. Observational studies suggested that low intake of a Western-pattern diet and high physical activity level reduced colorectal cancer mortality. The Theory of Planned Behaviour and the Health Action Process Approach have guided the design of intervention models targeting a wide range of health-related behaviours.

Methods/design

We aim to demonstrate the feasibility of two behavioural interventions intended to improve colorectal cancer outcome and which are designed to increase physical activity level and reduce consumption of a Western-pattern diet. This three year study will be a multicentre, randomised controlled trial in a 2x2 factorial design comparing the “Moving Bright, Eating Smart” (physical activity and diet) programme against usual care. Subjects will be recruited over a 12-month period, undertake intervention for 12 months and followed up for a further 12 months. Baseline, interim and three post-intervention assessments will be conducted.

Two hundred and twenty-two colorectal cancer patients who completed curative treatment without evidence of recurrence will be recruited into the study. Primary outcome measure will be whether physical activity and dietary targets are met at the end of the 12-month intervention. Secondary outcome measures include the magnitude and mechanism of behavioural change, the degree and determinants of compliance, and the additional health benefits and side effects of the intervention.

Discussion

The results of this study will establish the feasibility of targeting the two behaviours (diet and physical activity) and demonstrate the magnitude of behaviour change. The information will facilitate the design of a further larger phase III randomised controlled trial with colorectal cancer outcome as the study endpoint to determine whether this intervention model would reduce colorectal cancer recurrence and mortality.

Trial registration

ClinicalTrials.gov No: NCT01708824

Structural equation modeling for implementation intentions, cancer worry, and stages of mammography adoption

OBJECTIVES

This study aimed to develop a structural model for mammography adoption in Japanese middle-aged women by using constructs from the transtheoretical model (TTM), the theory of planned behavior (TPB), implementation intentions, and cancer worry.

METHODS

Questionnaires based on items including TTM, TPB, implementation intentions, cancer worry-related variables, and demographic variables were distributed to 1000 adult women aged 40 to 59 years, with 641 subjects being used in the final analysis (response rate = 64.1%).

RESULTS

Regarding the stage of adoption, 79 participants (12.3%) were at the precontemplation stage, 30 (4.7%) were at the relapse stage, 142 (22.2%) were at the contemplation stage, 88 (13.7%) were at the action stage, and 302 (47.1%) were at the maintenance stage. Our model, derived from structural equation modeling, revealed that the stage of mammography adoption was significantly affected by goal intentions, implementation intentions, perceived barriers, history of breast cancer screening, and relative risk. A logistic regression analysis revealed that goal intentions and implementation intentions significantly predicted mammography uptake within 1 year.

CONCLUSION

This study developed an integrated model constructed from TTM, TPB, implementation intentions, and cancer worry to account for mammography adoption in Japan, and also confirmed the predictive validity of the model.

The link between women's body image disturbances and body-focused cancer screening behaviors: a critical review of the literature and a new integrated model for women

A large body of literature demonstrates the association between body image disturbances and health compromising behaviors among women (e.g., pathological eating, substance use, inappropriate exercise). However, given that disturbed body image is a pervasive problem, it is likely inversely related to health maintenance behaviors. Cancer screenings for breast, skin, and cervical cancer represent an important type of health maintenance behavior, yet adherence rates are low. Given the body-focused nature of these screenings, body image may be a salient predictor. This paper reviews the literature on the relationship between body image disturbances and cancer screening behaviors among women culminating in the proposal of a theoretical model. This model posits that body shame and body avoidance predict performance of cancer screenings and that variables drawn from the cancer literature, including risk perception, health anxiety, subjective norms, and self-efficacy, may moderate this relationship. Clinical implications and suggestions for research are discussed.

Understanding cervical cancer screening intentions among Latinas using an expanded theory of planned behavior model

We examined the utility of an expanded theory of planned behavior (TPB) model in predicting cervical cancer screening intentions among Latinas. The model included acculturation and past cervical cancer screening behavior along with attitude, subjective norms, and perceived behavioral control. This cross-sectional study included a sample of 206 Latinas who responded to a self-administered survey. Structural equation modeling was employed to test the expanded TPB model. Acculturation (p = .025) and past screening behavior (p = .001) along with attitude (p = .019), subjective norms (p = .028), and perceived behavioral control (p = .014) predicted the intention to be screened for cervical cancer. Our findings suggest that the TPB is a useful model for understanding cervical cancer screening intentions among Latinas when both past behavior and culture are included. This research highlights the importance of culture on behavior and indicates a need to develop culturally sensitive, theory-based interventions to encourage screening and reduce cervical cancer-related health disparities in Latinas.

US female college students' breast health knowledge, attitudes, and determinants of screening practices: new implications for health education

OBJECTIVE

This study examined female college students' knowledge, attitudes, and breast cancer screening and determined significant predictors of breast self-examination, clinical breast examination, and mammography among this population.

PARTICIPANTS

A convenience sample of 1,074 college women from 3 universities participated in the research.

METHODS

Respondents completed an online version of the Toronto Breast Self-examination Instrument as well as questions developed by the authors.

RESULTS

Descriptive statistics showed gaps in college women's knowledge of breast health and negative attitudes toward screening that were relative to age. Multiple linear and logistic regression analyses revealed that knowledge, attitudes, and copay were significant predictors of screening, whereas family history and ethnicity were not.

CONCLUSIONS

This study supported previous smaller-sample studies that showed college women to be a priority population for breast health education and revealed new significant factors that should be addressed in health education for this group.

Mammography screening and the theory of planned behavior: suggestions toward an extended model of prediction

Mammography screening is probably the most effective method for the early detection of breast cancer. Existing models of health behavior, such as the theory of planned behavior, could improve their predictive validity and, therefore, their ability to promote health-related interventions by identifying additional factors associated with health decision making. This review provides an overview of research on factors related to mammography screening within the context of the theory of planned behavior and identifies the potential benefits of adding motivational factors, such as time perspective, optimism, and risk perception, in an attempt to enhance its explanatory power.

Attitudes and Beliefs Associated With Mammography in a Multiethnic Population in Israel

This article highlights beliefs, attitudes, and barriers that are associated with mammography use in four distinct cultural and ethnic groups in Israel: veteran, ultra-orthodox, and immigrant Jewish and Arab women. A random telephone survey of 1,550 women was performed. Information from claims records concerning mammography use was obtained for each woman from Maccabi Health Services. Of the barriers studied, no one barrier was associated with mammography performance in all population groups. However, the combined measure was associated with mammography use in all groups. Subjective norms, fatalism, fear of breast cancer, and perceived effectiveness were associated with mammography in some of the population groups but not in others. Each population seems to have a unique set of variables predicting mammography use. It is not possible to generalize from one population to another and it implies that information concerning beliefs and attitudes should be studied in each subpopulation before planning interventions.

Examining the theory of planned behavior and the construct of self-efficacy to predict mammography intention

This article examines the applicability of the Theory of Planned Behavior (TPB) with the addition of the self efficacy construct in the understanding of the motivation to obtain an initial screening mammogram among Cypriot women. The study sample consisted of 293 women aged 40 to 65 years, asymptomatic of breast cancer, and with no previous mammography experience. The study took place at the General Hospital of Nicosia in Cyprus. The results of the study provided support of the TPB with the addition of self-efficacy in an international setting. Self-efficacy was the strongest predictor of intention. Other predictors of intention included educational level, time of last clinical breast examination, and age. The study also provided some empirical support of the distinction between self-efficacy and perceived behavioral control. Researchers may want to include self-efficacy in addition to the TPB and other demographic characteristics in future applications to more fully explain behavioral outcomes.

What predicts a Cypriot woman's decision to obtain or not obtain a screening mammogram? Implications for the promotion of screening mammography in Cyprus

BACKGROUND

Breast cancer is an important public health issue in Cyprus. The purpose of the study was to assess: (a) the differences in motivational beliefs between women who decided to obtain a mammogram and women who did not; and (b) which beliefs predict the decision to get a mammogram.

METHODS

Data were collected through face-to-face interviews from 293 women (mean age = 52) at the outpatient clinics of the General Hospital of Nicosia. Variables of interests include demographics, other preventive behaviours, and cognitions. T-tests for independent samples and multiple logistic regression were the primary analytic techniques.

RESULTS

One hundred and eight women decided to obtain their first mammogram within the next 6 months. Deciders were more motivated to obtain a mammogram than non-deciders. Significant statistical differences were found regarding women's attitude, perceived social pressure, perceived control over environmental factors, and self-efficacy towards obtaining a mammogram. The self-efficacy beliefs as well as the physician recommendation were the most predictive factors in the decision to obtain a mammogram.

CONCLUSIONS

In the planning of successful educational campaigns promoting breast cancer screening in Cyprus, practitioners could focus on the following: (a) enhancing self-efficacy, (b) promoting a clinical environment conducive to mammography screening, and (c) encouraging physician recommendation.

Cognitive motivations associated with screening mammography in Cyprus

BACKGROUND

This study examined the relationship between cognitive motivations, demographic characteristics, related preventive health behaviors, and intention to obtain a first screening mammogram among Greek Cypriot women.

METHODS

This cross-sectional study took place at the outpatient clinics of the General Hospital of Nicosia during the fall of 1999. The participants were 293 women asymptomatic of breast cancer and with no previous mammographic experience. The Theory of Planned Behavior in conjunction with the construct of self-efficacy was used in the development of the questionnaire. The assessment also included demographic information, practice of other preventive health behaviors, and knowledge of breast cancer screening.

RESULTS

Self-efficacy was the most significant determinant of initial screening mammography, followed by normative beliefs associated with the physician, family and close friends, and perceived behavioral control beliefs related to barriers to obtaining a mammogram. Educational level, time of last clinical breast examination, and status of breast self-examination were also strongly implicated in the explanation of initial screening mammography.

CONCLUSIONS

Insights into specific salient motivational cognitions and certain demographic characteristics or related preventive health behaviors are crucial to the development and implementation of effective intervention strategies.