Testing a Model of Mammography Intention1

Disclosure of maternal HIV infection to children among Chinese women with HIV: The application of the Theory of Planned Behaviour and the role of various norms

Maternal HIV disclosure to children has numerous benefits for both mothers and children. However, the prevalence of maternal HIV disclosure to children remains low in many countries. The present study examined factors associated with intention to disclose maternal HIV status to children among Chinese HIV+ women who have not disclosed their HIV status to their child. Factors from the Theory of Planned Behavior and various norms (injunctive, descriptive and moral norm) were examined. Findings from 179 HIV+ women revealed that only 16.8% intended to disclose their HIV status to their child in the future. Adjusted for significant background variables, all factors from the TPB and various norms (i.e. attitude, injunctive norm, descriptive norm, moral norm, perceived behavioural control) were associated with intention to disclose HIV status (adjusted odds ratios ranged from 3.22, 15.85). Stepwise logistic regression showed that attitude (ORm = 6.96) and injunctive norm (ORm = 6.81) were associated with intention to disclose HIV status. Interventions to promote maternal HIV disclosure were warranted to promote attitude, perceived behavioural control, and various norms associated with HIV disclosure.

Explaining Routinized Decision Making

We review theories of preferential decision making and apply them to explain and predict the choices made by experienced individuals. Specifically, we focus on decision problems for which the actor already has a potential solution or routine available. We start with a brief overview of research evidencing the manifold ways in which such routines can influence the decision-making process. We then develop a classification of decision theories and examine their explanatory power, that is, the extent to which they can give post hoc explanations for routine effects. Finally, we narrow the analysis down to those theories that explicitly address routinized decision making and examine to what extent they are able to make a-priori predictions of routinized decision making. The review reveals that the arsenal of theories as a whole possesses a high potential to derive post-hoc explanations of routine effects with the help of some auxiliary assumptions. However, there are only a few decision theories that explicitly incorporate the influence of routines on choice. Examination of their predictive power reveals that we currently are not able to precisely predict information search, evaluation and context influences on choice in routinized decision making.

Testing Videotape Education for Heart Failure

This pilot study tested a videotape intervention designed to improve patient selfmanagement of heart failure (HF). Content of the video series (produced professionally under a federal grant) is based on national, scientifically validated guidelines for HF home management. Outcomes tested were HF knowledge, symptom reporting, and functional status. Participants were 10 newly diagnosed HF patients (mean age 67). After viewing the tapes, data indicated participants had a clinically relevant improvement in HF knowledge, and improved or maintained HF health status. None were rehospitalized during the 60-day follow-up period. One patient contacted his/her physician to report weight gain, as prompted by the videotapes. The cost data indicated that patients paid $177 out of pocket monthly for medications and all were low income. These results indicate the need for further testing of the videotape as a potentially cost-effective method of teaching aboutHFself-management and daily home self-monitoring.

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

BACKGROUND

Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories.

PURPOSE

We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior.

METHODS

We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n = 704). We compared direct, partial mediation, and full mediation models with Satorra-Bentler χ (2) difference testing.

RESULTS

Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers.

CONCLUSIONS

Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography.

The effects of routine strength on adaptation and information search in recurrent decision making

The strength of decision routines was manipulated within a computer-controlled micro world simulation involving recurrent decision making. During a learning phase, participants were led to prefer a certain brand of an industrial good either about 15 times in a weak routine or about 30 times in a strong routine condition. In the test phase of Experiment 1, participants were confronted with changes in the microworld that rendered the routine obsolete. Routine maintenance over a series of repeated acquisition decisions was assessed as the major dependent variable. Although new information clearly suggested that a deviation from the routine would be beneficial, strong routine participants were more likely to maintain the routine compared to weak routine participants and a control group in which a comparable option (same outcome probabilities as the routine) carried an unfamiliar brand label. Experiment 2 investigated the effects of routine strength on information search. After having learned the routine, participants were asked to make one final decision involving the routine. The task was either framed as being similar to the learning task or as being novel. Before making the final decision, participants were asked to consider new information about the alternatives. Strong routine participants in the familiar task condition preferred information that favored the routine and avoided unfavorable information. If the task was framed as being novel, such confirmation biases disappeared completely. In contrast, weak routine participants exhibited a moderate confirmation bias in their searches independent from task framing.

Prediction of intern attendance at a seminar-based training programme: a behavioural intention model

CONTEXT

The factors determining intern attendance at 'resident rounds' training programmes are not known.

AIMS

This study aimed to use a behavioural model (the Triandis theory of social behaviour) to predict intern attendance at the resident round programme at a metropolitan teaching hospital.

SUBJECTS

These included 109 interns in a large metropolitan teaching hospital, in the 1996 and 1997 cohorts.

METHODS

Tabulated responses from a structured interview administered to 10 randomly selected interns were used to develop survey items related to the Triandis variables. Attendance was monitored using a sessional logbook and by self-report. Item analysis was conducted for each variable scale. Stepwise multiple regression models were constructed to predict attendance and intention.

RESULTS

The average proportion of resident rounds attended was 43% (95% confidence intervals (CI) 40-47%) from logbook attendance, and 63% (95% CI 61-65%) by self-report. Cronbach's alpha for the subscales ranged from 0.62 to 0.91. Intern attendance was predicted by the habit of attendance and negatively predicted by facilitating conditions (AdjR2=0.26, P<0.0001). The intention to attend was only independently predicted by perceived consequences (AdjR2= 0.19, P < 0.0001).

CONCLUSIONS

The establishment of resident education programmes within teaching hospitals requires attention to and modification of facilitating conditions that may allow improvements in attendance and in quality of the programme.

Bestimmungsfaktoren der „Abbruchbereitschaft” von Auslandsentsandten: Eine theoretische und forschungsprogrammatische Analyse

Die vorzeitige Beendigung einer Auslandsentsendung durch den Mitarbeiter birgt für ein Unternehmen ein kostenintensives Problempotential. Da es sich hierbei um ein Verhalten des Mitarbeiters handelt, bietet es sich an, sich verhaltenswissenschaftlicher Erkenntnisse zu bedienen, um dieses Problem genauer zu untersuchen. Diese sollen mittels der Fluktuations-, Einstellungs-/Verhaltens- sowie der Anpassungsforschung gewonnen und gebündelt werden. Dabei wird „Abbruchbereitschaft” als operationalisierbare Größe vorgeschlagen. Es wird ein theoretischer Bezugsrahmen entwickelt, in dem neben externen Faktoren einstellungsbezogene, soziale und modale Faktoren als Bestimmungsfaktoren für „Abbruchbereitschaft” dienen. Forschungsprogrammatisch gesehen wird als Methode für eine empirische Überprüfung des Bezugsrahmens das „cognitive mapping” vorgeschlagen. Eine solche qualitative Herangehensweise verspricht, die Bestimmungsfaktoren (Informationskategorien), welche einer Bereitschaft zugrunde liegen, und deren Beziehungen zueinander genauer zu erfassen als quantitative Methoden.

Applying Decision-Making Approaches to Health Risk-Taking Behaviors: Progress and Remaining Challenges

This paper critically examines how risk-taking behaviors can be modeled from a decision-making perspective. We first review several applications of a decision perspective to the study of risk-taking behaviors, including studies that investigate consequence generation and the components of the overall utility (i.e., consequence, desirability, and likelihood) of risk-taking and studies that investigate the validity of two decision-oriented models (subjective expected utility and the theory of reasoned action) in predicting risk-taking behaviors. We then discuss challenges in modeling risk-taking behaviors from a decision-making perspective. These challenges include (i) finding the factors that are necessary to improve the predictability of models, (ii) difficulties in eliciting the individual components of overall utility, and (iii) incorporating overall utility changes over time. Copyright 1999 Academic Press.

A Motivational Message, External Barriers, and Mammography Utilization

Based on a theory of behavior, the interaction of a motivational message and external barriers on mammography utilization was tested. Participants (N = 101) had not had mammograms annually, and were identified from an urban clinic serving a disproportionally high percentage of indigent clients. Fifty-five percent were Caucasian; 45% were African-American. In an experimental design, half of the sample received a telephone discussion about rationale, feelings, and beliefs regarding mammograms, and half did not receive this contact. Four months later, nurses assessed women's recent mammography utilization and external barriers (e.g., affordability and accessibility). A logistic regression revealed an interaction between the intervention and barriers on postintervention mammography utilization (odds ratio: 2.12; p < 0.05). As proposed, the intervention was associated with a 64% rate of mammography utilization among women without barriers, but only a 26% rate among women with barriers. Not only should clinicians offer motivational messages about mammography, but also administrators should address external barriers to maximize mammography among socioeconomically disadvantaged groups.

Intention to have a mammogram in the future among women who have underused mammography in the past

This study investigated associations between confidence in one's ability to discuss mammography with health providers and to obtain regular mammograms (self-efficacy), social network members' attitudes toward mammograms (social influence), mammography experiences, and intention to have a mammogram in the next 1 to 2 years among women who were not in adherence with screening guidelines. Data were collected as part of a baseline assessment for a work site intervention study. Women 52 years and older completed a self-administered survey. Those not in compliance with screening guidelines (n = 194) were included in the analyses. Logistic regression revealed that self-efficacy and strong supportive social influences were significantly associated with mammography intention (odds ratio [OR] = 2.50, OR = 2.22, respectively), adjusting for prior mammography use. Findings suggest that interventions designed to promote mammography should build women's confidence in their ability to discuss mammography with health providers and to obtain regular mammograms. Intervention among social networks may also be an effective means of promoting mammography.

The theory of planned behavior: a review of its applications to health-related behaviors

PURPOSE

To review applications of Ajzen's theory of planned behavior in the domain of health and to verify the efficiency of the theory to explain and predict health-related behaviors.

METHODS

Most material has been drawn from Current Contents (Social and Behavioral Sciences and Clinical Medicine) from 1985 to date, together with all peer-reviewed articles cited in the publications thus identified.

FINDINGS

The results indicated that the theory performs very well for the explanation of intention; an averaged R2 of .41 was observed. Attitude toward the action and perceived behavioral control were most often the significant variables responsible for this explained variation in intention. The prediction of behavior yielded an averaged R2 of .34. Intention remained the most important predictor, but in half of the studies reviewed perceived behavioral control significantly added to the prediction.

CONCLUSIONS

The efficiency of the model seems to be quite good for explaining intention, perceived behavioral control being as important as attitude across health-related behavior categories. The efficiency of the theory, however, varies between health-related behavior categories.

The simultaneous analysis of patient, physician and group practice influences on annual mammography performance

The current study examined the relationship of several variables at the patient (n = 2780), physician (n = 166), and group practice (n = 45) levels for predicting receipt of annual mammography screening. Patient-level variables included constructs from the Triandis Model of Choice; physician-level variables included measures of barriers and receptivity to prevention, as well as demographic information. Hierarchical modeling demonstrated that variables at the patient and physician level reliably predict annual mammography screening, while frequency of screening did not vary across group practices after accounting for patient and physician variables. Patient-level predictors included social norms, perceived consequences and perceived barriers. The only physician-level predictor identified was annual mammography recommendation. These findings add to data which emphasize the importance of public education and social support in health maintenance activities.

Factors influencing registered nurses teaching breast self-examination to female clients

A university hospital-based study was conducted to explore factors that influence nurses teaching breast self-examination (BSE) to female clients, using the PRECEDE (Predisposing, Reinforcing, and Enabling factors in Educational Diagnosis and Evaluation) model as an organizing framework. Female registered nurses (N = 140) from adult inpatient and outpatient units completed a questionnaire that included items about frequency of BSE, knowledge of breast cancer screening and BSE technique, health motivation, confidence and competence in performing BSE, and teaching BSE. Data analysis compared the characteristics of nurses who reported teaching BSE with nurses who did not teach. Nurses in the teaching group had more work experience in nursing and were more likely to have a friend with breast cancer than were those in the nonteaching group. The teaching group had more knowledge about breast cancer screening and BSE technique and reported more confidence and competence in performing BSE.