Structural equation modeling to detect predictors of breast self-examination behavior: Implications for intervention planning

Associations of Attitudes and Practice Toward Oral Health, Socioeconomic Status, Self-Rated Oral Health, Subjective Oral Symptoms, and Oral Health-Related Quality of Life Among Residents in Eastern China: A Structural Equation Modeling Approach

Background and Purpose

The purpose of this study was to investigate the relationships among attitudes and practice about oral health, socioeconomic status, subjective oral symptoms, self-rated oral health, and oral health-related quality of life (OHRQoL) in a group of people from eastern China.

Methods

Between January 2021 to February 2022, 2502 (87.4%) of the 2863 participants completed an online questionnaire. OHRQoL, Socio-demographics characteristics, attitudes and practice toward oral health, self-rated oral health and subjective oral symptoms were all covered by the questionnaires. Based on the hypothetical model, structural equation modeling with the bootstrap method was used to examine the interactions and the strength of the correlations between the measured variables.

Results

The final model demonstrated acceptable data fit. Socioeconomic status (β = -0.051), attitudes (β = -0.100) and practice (β = -0.127) toward oral health, self-rated oral health (β = -0.493) and subjective oral symptoms (β = 0.294) were all significantly correlated with OHRQoL. Socioeconomic status was directly linked to attitudes (β = 0.046) and practice (β =0.070) about oral health, and attitudes play the role of intermediary between practice and socioeconomic status (β = 0.018). OHRQoL was indirectly linked with attitudes mediated by practice (β = -0.092), practice mediated by subjective oral symptoms (β = -0.107), subjective oral symptoms mediated by self-rated oral health (β = 0.031). OHRQoL was correlated with income, educational level, and socioeconomic status. Self-rated oral health was related to educational level and socioeconomic status.

Conclusion

In a sample of eastern China residents, OHRQoL was influenced by socioeconomic status, attitudes and practice toward oral health, subjective oral symptoms, and self-rated oral health.

Socioeconomic status index is an independent determinant of breast cancer screening practices: Evidence from Eastern China

BACKGROUND

Breast cancer is the most prevalent malignancy affecting Chinese women, and early routine screening is incredibly important for its prevention and control. This study aimed to investigate the role of socioeconomic status (SES) in female breast cancer screening practices using the composite SES index.

METHODS

This cross-sectional study involved 1816 women in Eastern China. Data were collected using an online self-administered questionnaire from January 2020 to May 2021. We used principal component analysis to construct the composite SES index using educational level, annual household income, and occupation. Logistic regression was used to analyze the association between the SES index and breast cancer screening utilization.

RESULTS

Of the participants, 19.27% reported having performed breast self-examination, 12.89% reported having undergone clinical breast examination, and 3.52% reported having received mammography. The SES has a significant influence on the patronage of female breast cancer screening in Eastern China. The composite SES index was found to have a positive and significant association with breast cancer screening practices. An interaction was found between the SES index and patient characteristics, such as health awareness, marital status, and location of residence. In addition, the SES index had a positive effect on breast cancer-related knowledge.

CONCLUSIONS

Socioeconomic inequalities existed in Eastern China and were related to breast cancer screening patronage. The composite SES index was identified as a significant determinant of breast cancer screening practices. Our results highlighted the negative impacts of socioeconomic inequities on female breast cancer screening utilization. This suggests that reducing socioeconomic inequalities in breast cancer screening requires more focused interventions and concerted outreach activities for groups with lower education levels, lower income, or lower occupational classes.

Predictors of breast self-examination behavior among adult females in Najran city, Saudi Arabia

AIM

This study aimed to explore the predictors of breast self-examination (BSE) behavior among adult females in Najran city, Saudi Arabia.

METHODS

A descriptive correlational design was utilized to recruit 1,075 participants from the primary health centers in Najran city, Saudi Arabia, from the beginning of March to the end of October 2021. A self-reported questionnaire was used for data collection; it consisted of demographic data and health history, breast cancer knowledge test and protection motivation theory (PMT) scale. Data analysis was performed using the Statistical Package for Social Science software, version 23 (IBM, Armonk, NY, USA).

RESULTS

Only 38.2% of the study participants had ever-performed BSE. Participants' knowledge, education, previous family history of breast cancer, and personal history of benign breast tumors are significant socio-demographic predictors of BSE behavior (p < .001). Also, the higher threats appraisal, reward appraisal, and efficacy appraisal increased the participants' probability of practicing BSE (p < .001) compared to a low level as references based on binary logistic regression results. In addition, low response cost was another predictor for BSE behavior compared with higher levels (p < .001).

CONCLUSION

Participants' knowledge, education, previous family history of breast cancer, and the PMT constructs (threats appraisal, reward appraisal, efficacy appraisal, and response cost) were significant predictors of BSE behavior.

Psychotherapeutic intervention on breast self-examination based on Health Belief Model

The aim of this research was to verify the effectiveness of a Health Belief Model-based intervention in increasing knowledge and changing beliefs about breast cancer and its early detection as well as in improving breast self-examination behaviors. This randomized controlled clinical trial involved 210 women. The program was implemented by email and involved sending daily messages to participants for 30 days. The women in the intervention group received messages aimed at increasing the practice of breast self-examination behavior. Participants in the control group received messages promoting general health. Before and after the intervention there were evaluated the application of breast self-examination, level of knowledge, beliefs associated with health (susceptibility to develop breast cancer, disease severity, benefits of self-examination, barriers to achieving this behavior, cues to action, self-efficacy in performing self-examination). At the end of the program, a significant improvement in the perception of disease severity and the benefits of breast self-examination was obtained, as well as a significant increase in the percentage of participants who achieved this behavior. The results obtained are arguments for it to be implemented by health care providers who want to promote self-examination as a method of early detection of breast cancer.

Relationship between demographic factors, health education, breast cancer-related knowledge, attitudes, and breast self-examination behavior among Chinese female college student: A structural equation analysis

AIMS

This study aimed to create a structural equation model to evaluate the associations among demographic factors, health education, breast cancer-related knowledge, attitudes, and breast self-examination behavior among Chinese female college students.

METHODS

A survey was undertaken using a self-administered questionnaire and targeting 2233 students from Eastern China. Structural equation modeling with the bootstrap approach was utilized to estimate the interrelationships and the strength of the associations among measured variables based on the hypothetical model.

RESULTS

Among the total participants, 14.7% of the female college students reported having performed breast self-examination. The final structural equation model showed highly satisfactory fitness on indices. Breast self-examination behavior was significantly linked to demographic factors, breast cancer related-knowledge, attitudes, and health education. Health education had the greatest influence on breast self-examination behavior. In addition, breast cancer related-knowledge was significantly associated with demographic factors and health education. Health education and knowledge all significantly affected attitudes towards breast cancer.

CONCLUSION

Breast self-examination behavior was influenced by demographic factors, breast cancer related-knowledge, attitudes towards breast cancer, and health education in a sample of female college students in China. Health education was the most important predictor of breast self-examination behavior.