Differences in health beliefs across stage of adoption of mammography in Iranian women

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.

Analyzing factors associated with decisional stage of adopting breast cancer screening among Korean American women using precaution adoption process model

Background: Korean American (KA) women have experienced higher prevalence and lower survival rates of breast cancer (BC) than other ethnic groups in the United States. However, BC screening rates for KA women remain significantly lower than the national target (81.1%) specified by Healthy People 2020. Few studies have explained how the decision to adopt BC screening occurs and progresses and what factors contribute to this decision among KA women. This study used Weinstein's Precaution Adoption Process Model (PAPM) as a theoretical framework to examine characteristics and factors associated with the decisional stage of mammography adoption.Methods: A cross-sectional self-report survey was administered among KA women (N = 308) ages 50-80 from the Atlanta metropolitan area. A total of 281 KA women completed the survey, answering questions about socio-demographics, health-related information, mammography history, doctor recommendation, BC screening knowledge, self-efficacy for BC screening, decisional balance scores on attitudes and beliefs pertaining to mammography, and the seven-stage PAPM.Results: KA women reported a low rate of mammography uptake with about 24% and 35% of the participants undergoing mammography within the last year and two years, respectively. KA women in stages 5 (decided yes), 6 (action), and 7 (maintenance) were likely to have increased screening-related knowledge, positive decisional balance, and regular medical check-up compared to those in stages 1 (unaware), 2 (unengaged), and 3 (deciding).Conclusion: This study highlights important factors that could potentially facilitate BC screening among KA women in Georgia. The findings also provide implications for interventions and practice for increasing mammography screening among medically underserved populations.

A review of barriers and facilitators to mammography in Asian women

Aim

Breast cancer is the most common cancer among women in Asia and one of the major health problems in most countries in the region. Despite extensive advances in treatment, early diagnosis is one of the main methods for increasing the survival rate. It is necessary to evaluate the barriers and facilitators of screening in different societies. This study was conducted to identify the barriers and facilitators of mammography in Asia.

Materials and methods

To identify the barriers and facilitators of mammography in Asia, a comprehensive search was carried out in databases such as Medline, Web of Science Core Collection and Scopus using keywords, including breast cancer, screening, mammography, barriers, facilitators and the names of each Asian country, as well as a combination of these keywords were used to help the search. Full-text, English language and original articles were included in this study.

Results

In total, 71 articles were entered into the study. The findings of this study revealed various barriers to mammography in Asian women, including knowledge, sociodemographic factors, cost and insurance, cultural factors, belief, attitude and feeling, fear, pain and embarrassment, self-efficacy, religious, psychological factors, time constraint, fatalism, professional recommendations, communication, social support and access. Also, knowledge, attitude and belief, perceived risk, professional and social factors were found to be facilitators of mammography.

Conclusion

Knowing the barriers and facilitators to access mammography is the first step in the development of a successful screening program. Awareness and various personal, professional and social factors have emerged as the major barriers to access to mammography in most Asian countries.

The Effect of Educational Intervention Based on the Theory of Planned Behavior on Mammography Screening in Iranian Women

Mammography is the most special screening method for early diagnosis of breast cancer. The purpose of present research is investigating the effect of educational intervention based on theory of planned behavior on mammography screening of women in Fasa city, Fars province, Iran. In this quasi-experimental study, 400 subjects (200 subjects for experimental group and 200 subjects for control group) were selected in 2017-2018. Educational intervention for the experimental group included 8 educational sessions. A questionnaire used for evaluating demographic information and constructs of theory of planned behavior (knowledge, perceived behavioral control, subjective norms, and attitude) investigated mammography performance of women before and 6 months after intervention. Data were analyzed by using SPSS 22 through chi-square test, McNemar's test, and Wilcoxon-Mann-Whitney test at significance level of P < 0.05. The average age of subjects was 45.52 ± 6.76 years in the experimental group and 45.12 ± 6.64 years in the control group. Six months after intervention, the experimental group showed significant increase in knowledge, perceived behavioral control, subjective norms, and attitude compared to the control group and 174 people (78%) of the experimental group had intention for doing mammography and 148 people (74%) of the experimental group performed mammography. Also, 6 months after educational intervention, 38 people (19%) of the control group had intention for performing mammography and 14 people (7%) of the control group performed mammography.

Validation of the Farsi version of the medical outcomes study-social support survey for mammography

BACKGROUND

Social support can provide psychosocial benefits to promote positive health behaviors such as mammography screening. The purpose of this study was to assess the psychometric properties of the Mammography Social Support (MSS) scale among Iranian woman.

METHODS

Participants were selected from women referring to healthcare centers in Sanandaj, Iran. A total of 434 questionnaires were completed (response rate 91%). The study sample for study 1 included 204 participants for the Exploratory Factor Analysis (EFA). Construct validity was determined by confirmatory factor analysis (CFA) using a study sample of 230 women in study 2. The reliability coefficient for each scale was calculated using Cronbach's alpha, corrected item-total correlations and test-retest respectively.

RESULTS

CFA affirmed the three-factor structure of the MSS in measuring the functional dimensions of social support for mammography behavior consisting of 19 items. Initial results of the CFA did not fully support the proposed three-factor model. After the model was modified, the fit indices indicated, x² was 2.3, Comparative Fit Index (CFI) = 0.96, Tucker- Lewis Index (TLI) = 0.95 providing a strong fit to the data. Cronbach's alphas for the subscales ranged from 0.82 and 0.90, whereas the alpha for the overall scale was 0.91. The 2-week test-retest reliability of MSS was 0.95.

CONCLUSION

This study provides evidence for the psychometric properties to support the Farsi version of the MSS when applied to Iranian women. Exploring the three-factor model in relation to related concepts is suggested for future studies.

Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research

PURPOSE

To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process.

METHODS

Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model.

RESULTS

Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented.

CONCLUSION

This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development.

Determinants of mammography adoption among iranian women: What are the differences in the cognitive factors by the stages of test adoption?

Our aim in this cross-sectional study was to investigate the predictors of the stages of change in mammography adoption (MA) based on Health Belief Model among Iranian women. Through multistage cluster sampling, we recruited and interviewed 1131 women older than 40. After statistical adjustment for other risk factors, perceived barriers (OR D 0.84, 95% CI D .81-.87) and benefits (OR D 1.17, 95% CI D 1.11-1.24) were significant predictors for MA. Majority of the women were in the pre-contemplation and contemplation stages of change for MA. Our findings are informative for the development of targeted interventions to foster MA among women.

Psychometric properties of the mammography self-efficacy and fear of breast cancer scales in Iranian women

Background

Research investigating mammography screening has often reported low mammography self-efficacy and breast cancer fear contribute to underutilization of mammography. This study aimed to examine the reliability and validity of Champion’s Mammography Self-efficacy Scale (CMSS) and Champion’s Breast Cancer Fear Scale (CBCFS) in a sample of Iranian women.

Methods

The adapted instruments were administered to a community sample of 482 women aged 40 years or older. They inhibited in Sanandaj, Iran. Cronbach’s α coefficients, item-total, and test-retest correlations were used to assess the reliability of the scales. Confirmatory factor analysis was applied to assess construct validity.

Results

The α coefficients for the Farsi 14-item CMSS and 8-item BCFS were .87 and.95, respectively. In terms of the CMSS confirmatory factor analysis, the proportion of x²/df was 2.4, Comparative Fit Index (CFI) = 0.93, Tucker Lewis Index (TLI) = 0.96 providing a strong fit to the data induced by two-factor model. With regard to CBCFS, x²/df was 86.33, CFI =0.99, and TLI =0.99 supporting one-factor model.

Conclusion

The CMSS and CBCFS exhibited strong initial psychometric properties; therefore, they are recommended to understand women’s breast cancer screening behaviors better.

Effects of a Randomized Controlled Trial to Increase Repeat Mammography Screening in Iranian Women

BACKGROUND

Although mammography use has increased in developed countries, regular screening in developing countries including Iran remains low. Multiple frameworks, including the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB), have been used to understand screening practices among Iranians. The HBM includes intrapersonal constructs such as perceptions of breast cancer and mammography. The TPB includes interpersonal and environmental constructs, such as perceived control and subjective norms.

OBJECTIVES

The current study had 2 objectives: (1) to examine changes in the HBM and TPB constructs and repeat mammography screening in women receiving either intervention and women in the control group and (2) to compare changes in the HBM and TPB constructs and repeat mammography screening across the 2 interventions.

METHODS

One hundred eight-four women from 3 randomly selected health centers in Sanandaj, Iran, participated. Eligibility criteria were being 50 years or older, having received a mammogram in the past 2 to 3 years, and no intention to obtain a mammogram within the next year.

RESULTS

The TPB and HBM participants exhibited greater changes in the HBM and TPB constructs and were more likely to have a mammogram relative to control participants. The TPB and HBM participants exhibited comparable changes in constructs and repeat mammography.

CONCLUSION

Findings suggest both interventions equally improved mammography screening. Additional studies are furthermore warranted to address nonadherent Iranian women's needs in line with these conceptual models.

IMPLICATIONS FOR PRACTICE

Use of the HBM and TPB constructs in clinical practice may be helpful to promote continued screening among this population.

The relationship of social support concept and repeat mammography among Iranian women

BACKGROUND

Breast cancer ranks as the first most common cancer among the Iranian women. The regular repeat of mammography with 1-2 year intervals leads to the increased efficiency of early detection of breast cancer. The present study examined the predictors of repeat mammography. It was hypothesized that higher social support is connected with mammography repeat.

METHODS

A cross-sectional study was carried out among 400 women 50 years and older in Sanandaj, Iran. Data was collected by the questionnaire including information on socio demographical variables and measuring social support level. Data was analyzed by SPSS16 software. Multiple logistic regression was used to determine the predictive power of demographic variables and dimensions of social support for repeat mammography.

RESULTS

Women aged 50-55 years had three times odds of repeat mammography compared to women aged 56-60 years) OR, 3.02). Married women had greater odds of repeat mammography compared to single women (P < 0.006). The probability of repeat mammography in women with higher social support was 0.93 times greater than the women with lower social support (OR, 0.93; 95 % CI, 0.91-0.95; P < 0.0001).

CONCLUSIONS

Iranian women are less likely repeat mammography than other Asian women. Identifying the associations between perceived social support and repeat mammography may offer detailed information to allow for future study and guide the development of interventions not only for Iranian women but also for similar cultural that received pay too little attention to date in the breast cancer literature.