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

Increasing Uptake of Prescription Drug Take-Back Boxes: Eliciting Preferences and Applying the Theory of Planned Behavior to Predict Use

This study assesses adults' perceptions of and predictors of intention to use prescription drug take-back boxes. This mixed methods study utilized focus groups and an online survey to examine factors related to intention to use a prescription drug take-back box. This study was conducted in [State] during the spring and summer of 2018. Themes identified in focus group data included the importance of take-back box location, benefits of take-back box use (such as reducing opportunities for medication misuse), and barriers to take-back box use (such as lack of awareness, stigma associated with law enforcement). Survey results indicate that pharmacies are the most preferred take-back box location and that attitudes, subjective norms, and perceived behavioral control are statistically significant predictors of intention to use a take-back box. Results suggest that individuals are open to using take-back boxes in secure, convenient locations, but many are unaware of take-back boxes as an option for safe disposal. These findings have implications for health communication and policy efforts designed to increase the use of take-back boxes for prescription drug disposal.

Predictors of Human Papillomavirus Vaccine Intention and Uptake Among US Hispanic Parents: A Cross-Sectional Study

Introduction: This study explored the influence of the Theory of Planned Behavior constructs on human papillomavirus (HPV) vaccine (HPVV) intentions and uptake among Hispanic parents in South Florida for their children aged 9-21. Method: A descriptive exploratory analysis was conducted using 39 surveys completed by Hispanic parents. These surveys encompassed demographic data and questions about HPVV uptake, intention, attitudes, subjective norms, knowledge, self-efficacy, and awareness. Results: Most participants were uninsured (77%), unemployed (59%), and had low Americanism acculturation (74%). A little over half were aware of the HPVV (54%), yet most had high positive HPVV attitudes (95%) and self-efficacy (85%). HPVV intentions within the year were also high (82%); however, HPVV uptake (45%) and HPVV knowledge (40%) were low at the time of the study. Most parents reported physicians (72%) and nurses/nurse practitioners (59%) as the most influential individuals in their decision-making. A statistically significant relationship between HPVV intention and HPVV attitude (X_Wald^2 (1) = 5.71, p = 0.02., OR = 5.11) and between HPVV uptake and HPVV awareness (X_Wald^2 (1) = 4.63, p = 0.03., OR = 12) were observed. Conclusion: This study recommends further research and targeted interventions to improve HPVV awareness among Hispanic communities. The participants' highly positive attitudes and self-efficacy provide a hopeful outlook for future vaccination efforts within this demographic.

Concept mapping sociocultural aspects of cervical cancer prevention among African American women

Introduction

For African American women in Houston, cervical cancer mortality is disproportionate to their racial and ethnic counterparts. Most notably, lack of human papillomavirus (HPV) screening and vaccination as well as late diagnosis increase cervical cancer mortality. However, cervical cancer is largely preventable. While previous research has identified a few social determinants that are specifically related to cervical cancer (e.g., education, income, neighborhood), there may be a host of additional social and cultural factors that contribute to a lack of preventative behavior.

Methods

The present study used concept mapping to explore sociocultural determinants of cervical cancer prevention beliefs among young African American women. N = 15 African American women, ages 18-25, participated in a group concept mapping session focused on cervical cancer knowledge, beliefs about women's health, and how their social environment and culture play a role in their conceptualization of cervical cancer prevention.

Discussion

Five overarching concepts emerged: (1) Screening, (2) Support System, (3) Cervical Cancer 101 (knowledge), (4) Fatalism, and (5) Ease of Prevention.

Conclusion

The present study highlights the use of concept mapping for prevention science, particularly in exploratory studies for understanding cervical cancer screening barriers, avenues for intervention, and public health messaging. We discuss the findings and implications for public health research in cervical cancer prevention tailored for African American women.

Development, acceptability and usability of culturally appropriate survivor narrative videos for breast cancer treatment in Botswana: a pilot study

OBJECTIVES

Narrative communication has demonstrated effectiveness in promoting positive health behaviours, delivering support and coping with complex decision-making. Formal research evaluating this intervention for cancer treatment in Africa is lacking. We aimed to develop, and assess acceptability and usability of survivor video narrative interventions for breast cancer treatment in Botswana.

DESIGN

A pilot study design.

SETTING

Single-centre, tertiary hospital, sub-Saharan Africa.

PARTICIPANTS

Eight women, ≥18 years old, with stages I-III breast cancer were enrolled for the video intervention. 106 women, ≥18 years old, with stages I-IV breast cancer viewed the narrative videos and 98 completed the acceptability and usability surveys.

INTERVENTION

Survivor narrative videos were developed using the theory of planned behaviour and using a purposive sample of Batswana, Setswana-speaking, breast cancer survivors, who had completed systemic treatment and surgery with high rates of adherence to the prescribed treatment plan.

PRIMARY OUTCOMES

We assessed acceptability and usability among prospectively enrolled patients presenting for routine breast cancer care at Princess Marina Hospital in Botswana, using a 13-item survey.

RESULTS

Participants expressed high acceptability and usability of the videos, including 99% (97/98) who strongly agreed/agreed that the video presentations were easy to understand, 92% (90/98) who would recommend to other survivors and 94% (92/98) who wished there were more videos. Additionally, 89% (87/98) agreed or strongly agreed that the one-on-one instruction on how to use the tablet was helpful and 87% (85/98) that the video player was easy to use.

CONCLUSION

Culturally appropriate survivor video narratives have high acceptability and usability among patients with breast cancer in Botswana. There is an opportunity to leverage this intervention in routine breast cancer care for treatment support. Future studies will test the implementation and effectiveness of narrative videos on a wider scale, including for patients being treated for other cancers.

"Black Women Don't Always Put Our Healthcare First": Facilitators and Barriers to Cervical Cancer Screening and Perceptions of Human Papillomavirus Self-Testing Among Church-Affiliated African American Women

Background: African American women are at greater risk for cervical cancer incidence and mortality than White women. Up to 90% of cervical cancers are caused by human papillomavirus (HPVs) infections. The National Institutes of Health (NIH) co-developed HPV self-test kits to increase access to screening, which may be critical for underserved populations. Purpose/Research Design: This mixed methods study used the Theory of Planned Behavior to examine attitudes, barriers, facilitators, and intentions related to receipt of cervical cancer screening and perceptions of HPV self-testing among church-affiliated African American women. Study Sample/Data Collection: Participants (N = 35) aged 25-53 participated in focus groups and completed a survey. Results: Seventy-four percent of participants reported receipt of cervical cancer screening in the past 3 years. Healthcare providers and the church were supportive referents of screening. Past trauma and prioritizing children's healthcare needs were screening barriers. Concerns about HPV self-testing included proper test administration and result accuracy. Conclusions: Strategies to mitigate these concerns (e.g., delivering HPV self-test kits to the health department) are discussed.

Stigma and Social Determinants of Health Associated With Fidelity to Guideline-Concordant Therapy in Patients With Breast Cancer Living With and Without HIV in Botswana

BACKGROUND

Patients with breast cancer in sub-Saharan Africa (SSA) experience a disproportionate burden of mortality. Fidelity to treatment guidelines, defined as receiving optimal dose and frequency of prescribed treatments, improves survival. We sought to identify patient factors associated with treatment fidelity and how this may differ for people with HIV (PWH) and breast cancer.

METHODS

We conducted a qualitative study of women who initiated outpatient treatment for stages I-III breast cancer in Botswana, with deviance sampling of high- and low-fidelity patients. One-on-one interviews were conducted using semi-structured guides informed by the Theory of Planned Behavior. The sample size was determined by thematic saturation. Transcribed interviews were double coded with an integrated analytic approach.

RESULTS

We enrolled 15 high- and 15 low-fidelity participants from August 25, 2020 to December 15, 2020, including 10 PWH (4 high, 6 low fidelity). Ninety-three percent had stage III disease. Barriers to treatment fidelity included stigma, social determinants of health (SDOH), and health system barriers. Acceptance and de-stigmatization, peer and other social support, increased knowledge and self-efficacy were identified as facilitators. The COVID-19 pandemic amplified existing socioeconomic stressors. Unique barriers and facilitators identified by PWH included intersectional stigma, and HIV and cancer care integration, respectively.

CONCLUSION

We identified multilevel modifiable patient and health system factors associated with fidelity. The facilitators provide opportunities for leveraging existing strengths within the Botswana context to design implementation strategies to increase treatment fidelity to guideline-concordant breast cancer therapy. However, PWH experienced unique barriers, suggesting that interventions to address fidelity may need to be tailored to specific comorbidities.

Effects of safety interventions toward workers' behaviors using the theory of planned behavior in the rubber wood processing industry

Objectives. Rubberwood manufacturing has a wide range of occupational safety hazards. Workers' safety behaviors are substandard. This quasi-experimental study aimed to determine the factors affecting safety behaviors using the theory of planned behavior (TPB) and compare the effects of safety intervention programs on workers' behaviors. Methods. The sample comprised workers from a rubberwood processing factory. Exploratory and confirmatory factor analyses were performed to validate the TPB constructs. The constructs were also analyzed before and after the interventions using structural equation modeling to confirm the observed variables. The interventions included conducting job safety analysis, establishing safety standard operation procedures and launching a behavioral promotion campaign. A t test was used to compare the constructs' intervention effects. Results. The structural equation model adequately fit the data and confirmed that the constructs were aligned with the TPB. Most path coefficients were statistically significant after the interventions were implemented. 'Attitude' and 'perceived behavioral control' directly and significantly affected 'intention'. 'Intention' was an essential mediator to 'behaviors'. The improvement in workers' behaviors was evident. Conclusions. According to the TPB, safety program interventions helped enhance workers' behaviors. Hence, based on participatory approaches, sustainable safety interventions should be maintained for all levels of personnel in the organization.

Determinants of Low-Income Women's Participation in Self-Collected Samples for Cervical Cancer Detection: Application of the Theory of Planned Behavior

BACKGROUND

Low-income women (LIW) are underrepresented in physician-provided cervical cancer screening. Providing women with an option for Human Papillomavirus (HPV) self-sampling would increase cervical cancer screening. However, little is known about LIW's attitude towards self-sampling for cervical cancer. We determined the associations between the Theory of Planned Behavior (TPB) constructs and LIW intention for participation in the HPV self-sampling.

METHODS

A 44-item survey was administered among women receiving food from a food pantry in central Texas. Independent variables included TPB constructs (i.e., attitudes, subjective norms, and perceived control). The outcome variables were intentions and preference for self-sampling. Both variables were measured on a 5-point scale. Hierarchical linear regression models were used to analyze the data.

RESULTS

A sample of 241 participants (age 50.13 ± 9.60 years) comprising non-Hispanic White (40%), Black/African American (27%), and Hispanic (30%) participated in the study. The participants were current with a pap test (54.8%) and preferred self-sampling (42%). The participant's attitudes and subjective norms were significantly associated with their intention for self-sampling, accounting for 38.7% of the variance (p < .001). Women who were overdue for pap testing versus current with pap testing had increased odds of preferring self-sampling (OR = 1.72, 95% CI: 1.27, 6.04).

CONCLUSIONS

The key predictors for LIW's intention for self-sampling included attitudes and subjective norms. Future research should use the TPB as a framework to examine whether intention predicts self-sampling behavior among LIW.

Comparison of Narrative Video and Flipchart Presentation to Promote Cervical Cancer Screening Among Latinas Along the Border

INTRODUCTION

Cervical cancer incidence and mortality is higher among Latinas compared with non-Hispanic White women and barriers to screening include lack of knowledge, lack of access to health care, and cultural factors. Both video and printed material have been found effective as health education tools in underserved populations. The purpose of this study was to show no difference between a flipchart presentation facilitated by a community health worker and a narrative video with limited in-person interaction in increasing cervical cancer screening rates among Latinas along the U.S.-Mexico border.

METHODS

Study design: Randomized controlled study. Participants: women in a community-based cervical cancer screening program.

OUTCOMES

Primary outcome was screening completion and secondary outcomes were changes in psychosocial variables.

RESULTS

Total sample size was 500. Most participants were born in Mexico, had a low annual income, preferred Spanish, and did not have a regular doctor. Overall, 371 (74.2%) participants completed screening. There was no significant difference in screening completion between educational delivery modes. The only variable significantly associated with screening completion was age, with 51- to 65-year-olds being 44% more likely than 21- to 40-year-olds to have a Pap test. The only psychosocial variable that was significantly different by delivery mode was perceived susceptibility. The majority of all participants found both the video and flipchart presentation to be acceptable.

CONCLUSION

A health promotion program delivered via self-administered video or PowerPoint slides showed no difference in increasing cervical cancer screening rates.

Predictive power of PEN-3 cultural model in cervical cancer screening among women: a cross- sectional study in South of Iran

BACKGROUND

Cervical cancer (CC) can be prevented through early detection facilitated by screening as well as an early diagnosis and effective treatment of the precancerous lesions. The present research aimed to determine the predictors of cervical cancer screening (CCS) based on the PEN-3 model constructs.

METHODS

A cross-sectional study was conducted between September 2021- March 2022 with 840 women aged 15-49 in the city of Bandar Abbas, in the south of Iran, using a cluster sampling. The participants completed a valid and reliable self-administered questionnaire in person. The questionnaire included demographic characteristics, knowledge toward CC and the constructs of the PEN-3 model toward CCS. A multivariable logistic regression was used to determine the relationship and predictive power of model constructs with behavior as an outcome variable. The data were statistically analyzed in STATA14.2. The p-value < 0.05 was considered statistically significant.

RESULTS

A total of 810 questionnaires were analyzed (with a return of 95.63%). The mean and standard deviation of the participants' age was 30.97 ± 5.80 years. Pearson correlation coefficient analysis of all constructs and CCS behavior was statistically significant (P-value < 0.05). The multivariable logistic regression analytic results were enablers toward CCS (coefficient: 0.275) and Nurturers toward CCS (coefficient: 0.182), perceptions toward CCS (coefficient: 0.077) and knowledge toward CC (coefficient: 0.048, marginal significant) were predictors of CCS behavior. For the internal validity of the designed prediction model, a sample of 1000 was selected using the bootstrap sample replacement method which demonstrated the accuracy of the model PEN-3 is about 75% in predicting CCS behavior.

CONCLUSIONS

The results of the present research showed that personal factors such as perceptions and interpersonal factors such as enablers and nurturers toward CCS can predict CCS behavior. Therefore, in order to increase the acceptance of CCS in women, a set of intrapersonal and interpersonal factors should be taken into account.

HBV screening among West Africans living in the US: Influences of stigma, health literacy, and self-efficacy

BACKGROUND

Applying theoretically informed constructs using an adaptation of the "Theory of Planned Behavior," this study assessed social-cognitive and sociocultural determinants of HBV screening among West Africans living in the US to inform solutions to testing gaps.

METHODS

We developed and administered a theory-based survey in both English (41%) and French (59%) from September 2021 to April 2022 to a sample of West African-born individuals (n = 162). Predictors of HBV screening included: attitudes, perceived behavioral control or self-efficacy, and subjective norms along with health literacy (HL), language proficiency, and stigma of HBV infection. We hypothesized that these constructs would predict HBV testing. We also conducted path analytic modeling to better understand both direct and indirect effects of key factors on HBV screening status.

RESULTS

West Africans who completed the survey in English were younger with less education and lower income, whereas those who completed the survey in French reported higher HBV-related stigma. In a bivariate analysis of factors associated with HBV screening by language, less education was associated with lower HBV screening in English speakers. Adequate HL, higher self-efficacy, and higher English language proficiency were independently associated with HBV screening. Path analysis to better understand the interplay between social-cognitive and sociocultural factors revealed HL and stigma both had indirect effects on screening, mediated by differences in self-efficacy.

CONCLUSIONS

This study identified HL and stigma as key indirect factors that influence HBV screening by way of self-efficacy in West Africans in the US. This work is a first step to identifying barriers that can lead to the development of an evidence-based intervention aimed at increasing HBV screening of West Africans to address health disparities.

Predictors of participation in atrial fibrillation screening among community residents in China

BACKGROUND

Atrial fibrillation (AF) is associated with increased stroke risk, but many cases of AF remain undiagnosed. Screening is suggested for early detection of AF. However, nonparticipation in screening is frequently reported, and the underlying causes of why patients choose to participate or not are poorly understood.

OBJECTIVES

To explore factors associated with participation in AF screening in a high-risk population in China.

METHODS

A cross-sectional study was conducted among community residents who were at risk for AF in Guangzhou, China, from February to September 2022. Data on AF knowledge, attitude, subjective norms, perceived behavioral control, and willingness to participate in AF screening were collected. Sociodemographic and clinical data were also collected. Multiple linear stepwise regression analysis was performed to explore predictors for participation in AF screening.

RESULTS

In total, 420 participants were included, with a mean age of 74.4 (±7.43) years old. The results showed that 77.4% of participants reported that they were likely to participate in AF screening. The results of multiple linear regression showed that perceived behavioral control (β =0.591, 95% CI: 0.071, 0.094), attitude (β =0.085, 95% CI: 0.001, 0.025), and having an AF diagnosis (β =0.098, 95% CI: 0.068, 0.494) were positively associated with willingness to participate in AF screening.

CONCLUSIONS

Chinese patients are more likely to participate in AF screening when they perceive great control over their behavior, hold a positive attitude, and have an AF diagnosis. The findings provide clues for future interventions aimed at improving the AF screening participation rate.

Using planned behavior theory to understand cervical cancer screening intentions in Chinese women

Introduction

Cervical cancer is still one of the cancers threatening the health of Chinese women with high morbidity and mortality. However, the participation rate of cervical cancer screening (CCS) among women is low due to various reasons, so it is crucial to understand the factors that influence women's willingness to be screened for cervical cancer. This study's goal was to understand the intention of cervical cancer screening in Chinese women using the theory of planned behavior (TPB).

Methods

An online questionnaire was administered to 286 women using a cross-sectional design. The questionnaire was created using the theory of planned behavior and included demographic characteristics as well as the basic structure of TPB.

Results

Descriptive, correlation, and multiple linear regression models were performed to identify factors associated with cervical cancer screening behavior. 286 respondents completed the survey (95.3%). The mean scores for behavioral attitude, subjective norm and perceived behavioral control (PBC) were 32.50 (SD = 3.30), 22.59 (SD = 2.80) and 29.57 (SD = 3.37). From the regression analysis, behavioral attitude (B = 0.110, p = 0.001), subjective norm (B = 0.234, p = 0.000) and perceived behavioral control (B = 0.171, p = 0.000) were statistically significant in terms of intention.

Discussion

This study provided a reference for improving the intention of cervical cancer screening in women.

Predictors of intention to receive cervical cancer screening among commercial sex workers in Gondar city, northwest Ethiopia: application of the theory of planned behavior

BACKGROUND

Cervical cancer is a global public health problem & is the fourth leading cause of cancer morbidity and mortality. Abnormal cervical lesion is common in commercial sex workers and is at a higher risk of developing cervical cancer due to multiple sexual partners besides other factors. Intention is an important predictor of behavior and is an initiative to transform their desire into action. Therefore, this study aimed to assess the predictors of intention to receive cervical cancer screening among commercial sex workers in Gondar city, northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted from March 27 to May 25, 2021, in Gondar city, northwest Ethiopia. A total of 425 commercial sex workers selected using convenience sampling techniques were included in the study. Linear regression with robust standard errors was carried out to identify predictors of intention to receive cervical cancer screening. A 95% confidence interval and a p-value of less than 0.05 were used to declare statistical significance.

RESULTS

A total of 393 commercial sex workers participated in the study with a response rate of 92.4%. The mean age of the participants was 27.68 ± 6.62. The median (interquartile range) of intention was 4 (3-4.25). The theory of planned behaviour variables explained 38.51% of the variance in intention to receive cervical cancer screening. Direct subjective norm (β = 0.09), 95% CI (0.05, 0.13)), direct Attitude (β = 0.09, 95% CI (0.04, 0.13)), past behaviour (β = 0.27; 95% CI (0.09, 0.46), and positive HIV status (β = 0.26; 95% CI (0.06, 0.46) were significant predictors of intention.

CONCLUSIONS

Commercial sex workers' intention to undergo cervical cancer screening was high. The theory of planned behavior showed adequate utility in predicting commercial sex workers' intention to receive cervical cancer screening. Participant's attitudes, subjective norm, past behavior, and positive HIV status were important factors affecting their intention to receive cervical cancer screening. Thus, interventions aimed at enhancing commercial sex workers' cervical cancer screening behavior should target creating positive social pressure and attitudinal change towards cervical cancer screening.

Racial and ethnic differences in cervical cancer screening barriers and intentions: The My Body My Test-3 HPV self-collection trial among under-screened, low-income women

Under-screened women are more likely to be diagnosed with invasive cervical cancer at later stages and have worse survival outcomes. Under- or un-insured women, low-income women, and minoritized groups face barriers to screening. Intention to screen is an indicator of future screening behavior, yet is understudied among low-income, under-screened women. Participants were 710 low-income, uninsured or publicly insured women ages 25-64 years in North Carolina who were not up to date on cervical cancer screening according to national guidelines. Participants were asked about barriers to screening and intention to screen. We estimated reported barriers to cervical cancer screening stratified by race and ethnicity (categorized as White, Black, and Hispanic) and assessed predictors of intention to screen. Sixty-one percent of all participants reported 5 or more barriers to screening. The most commonly reported reasons for not getting screened were lack of insurance (White: 71%, Black: 62%, Hispanic/Latina: 63%) and cost (White: 55%, Black: 44%, Hispanic/Latina: 61%). Women were more likely to have an intention to screen if they reported "it was not hard to get screening" (OR: 1.47 (1.00, 2.15)). Older women reported being less likely to intend to screen. Black women reported being more likely to intend to screen than White women. Lack of health insurance and cost were frequently reported barriers to cervical cancer screening. Increasing knowledge of affordable clinics and expanding access to Medicaid may reduce barriers and increase cervical cancer screening uptake.

Survey on determinants of intention to reduce nasopharyngeal cancer risk: an application of the theory of planned behavior

Background

To have better prognostic outcomes and minimize deaths due to nasopharyngeal cancer, it is vital to understand factors that motivate the public to undertake cancer preventive measures. The study investigated determinants of intention to adopt measures to reduce nasopharyngeal cancer risk using the Theory of Planned Behavior.

Method

A cross-sectional survey was conducted on Malaysians (n = 515) using a questionnaire on attitudes, subjective norm, perceived behavioral control, knowledge of nasopharyngeal cancer, past nasopharyngeal cancer preventive behavior, and intention to adopt preventive measures. The attitudes construct encompassed perceptions of susceptibility, severity, benefits and barriers. Hierarchical regression of mediation effect under structural equation model approach was used to test the theory. The model was re-estimated using the two-stage least square approach by instrumental approach. Next the Maximum Likelihood Estimation-Structural Equation Modeling was conducted to gauge the instrumentation and check the robustness of the model’s simultaneity.

Results

The respondents had moderate knowledge of nasopharyngeal cancer, and reported high levels of perceived risk, perceived severity and perceived behavioral control. The respondents were under little social pressure (subjective norm) to perform nasopharyngeal cancer preventive actions, marginally believed in the benefits of medical tests and reported few barriers. The Partial Least Squares-Structural Equation Modeling results show that the relationship between intention and four independent variables were significant (perceived behavioral control, perceived risk, perceived severity, marital status) at p < .05. Tests of Two-stage Least Square Approach and Maximum Likelihood Estimation-Structural Equation Modeling confirm the four key factors in determining the intention to reduce nasopharyngeal cancer risk. The variance explained by these factors is 33.01 and 32.73% using Two-stage Least Square Approach and Maximum Likelihood Estimation-Structural Equation Modeling respectively. Intention to undertake nasopharyngeal cancer risk-reducing behavior has no significant relationship with subjective norm, attitudes (perceived benefits and barriers to screening), knowledge of nasopharyngeal cancer and past behavior in enacting nasopharyngeal cancer preventive measures. The only demographic variable that affects intention is marital status. Gender, age, race, religion, education level, and income are not significantly associated with intention.

Conclusions

In contexts where knowledge of nasopharyngeal cancer is moderate, the factors associated with the intention to reduce risk are perceived risk and severity, perceived behavioral control, and marital status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14073-0.

Breast self-examination as a route to early detection in a lower-middle-income country: assessing psychosocial determinants among women in Surabaya, Indonesia

Background

Breast cancer has become a public health concern in Indonesia. Regular breast self-examination (BSE) is considered an important first step for its early detection, especially in countries with limited healthcare access, as it is the case in Indonesia. This study aimed to confirm and assess the psychosocial determinants of intention to perform BSE and BSE performance.

Methods

The cross-sectional study was conducted on 204 women aged 18–65 years in Surabaya, Indonesia. A 64-item survey was conducted, included variables from the Reasoned Action Approach, and the Health Belief Model, presented questions about demographics, breast cancer knowledge, and behavior related to BSE.

Results

Most women (72.5%) expressed intention to perform BSE; however, only 7.8% and 2.9% performed BSE per week and per month, respectively, in the past year. Breast cancer knowledge and attitudes towards BSE were uniquely associated with BSE performance. Perceived behavioral control (PBC) and BSE attitudes were unique correlates of intention. Perceived benefits and barriers and subjective norms were significantly associated with intention and BSE behavior in bivariate analyses.

Conclusions

Breast screening education should incorporate strategies for improving attitudes towards BSE, PBC, and breast cancer knowledge with perceived benefits and barriers and subjective norms as relevant targets.

‘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.

A Critique of the Theory of Planned Behavior in the Cancer Screening Domain

The theory of planned behavior (TPB) has been widely used to guide research in cancer screening-related behavior, but no critique of the TPB's application in this domain has been published. We used Fawcett and DeSanto-Madeya's 2013 framework to analyze and evaluate the theory. The theory was developed on the basis of antecedent knowledge regarding human behavior, and its concepts and propositions are comprehensively delineated. The TPB shows adequate internal consistency and impressive social and theoretical significance. Methodologically sound studies are called for to further test some theory propositions and to evaluate its pragmatic adequacy for promoting cancer screening in nursing practice.

Change in individual physicians' screening mammography completion rates following the updated USPSTF guideline supporting shared decision making: An observational cohort study

OBJECTIVE

To understand changes in physician screening practices in response to the 2009 U.S. Preventive Services Task Force recommendation supporting shared decision making (SDM) for mammography in women aged 40-49 years.

METHODS

We assessed screening completion rates for physicians in the Cleveland Clinic Health System pre-2009 (2006-2008) and post-2009 (2010-2015), and rates for physicians new to the system post-2009. We used mixed effects logistic regression to estimate the odds of a woman receiving screening post-2009. If physicians practiced SDM, we hypothesized their screening rates would change after 2009. To test this, we included each physician's pre-2009 screening rate as a predictor in the model.

RESULTS

Among 125 physicians, the screening rate increased from 40% to 45% from pre-2009 to post-2009. For physicians new to the health system post-2009 the rate was 32%. In the mixed effects model (N = 17,007), the strongest predictor of mammography receipt among patients post-2009 was their physician's pre-2009 screening rate (aOR:3.57 per 10% increase in pre-2009 rate; 95%CI:1.69-7.50).

CONCLUSIONS

Whether a woman received a mammogram post-2009 was highly associated with her physicians' pre-2009 screening rate, suggesting physicians are not individualizing screening decisions via SDM.

PRACTICE IMPLICATIONS

Physicians may need support to effectively practice SDM.

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.

Social distancing intentions to reduce the spread of COVID-19: The extended theory of planned behavior

BACKGROUND

Due to the absence of a vaccine of SARS-CoV-2 virus pandemic, the most effective way to reduce transmission of the virus is by applying social distancing practices. Exploring factors that determine whether people adopt social distancing measures is, therefore, critical to reducing the spread of the virus. This study aimed to investigate people's intentions to socially distance based on the extended Theory of Planned Behavior.

METHODS

A questionnaire was distributed to the sample population and collected through social media online and WhatsApp groups from March 26, 2020 to March 29, 2020. There were 823 analyzed out of 1870 responses. The extended TPB variables and risk perception were measured using a 7-point scale (scored from 1 to 7). Data were analyzed using the partial least squares (PLS) structural equation modeling method.

RESULTS

Study found that the factors influencing the intention to perform social distancing were subjective norms and perceived behavior control. Risk perception affected attitudes, subjective norms, and perceived behavioral control. Media exposure was found to determine attitudes, subjective norms, and risk perceptions. The relationship between attitudes and intentions, and media use and perceived behavior control were not significant. The better and effective risk communication that can change the level of risk perception, raise family and religious leader as well as increase to control behavior are the keys to people's perform social distancing. Results from a multigroup analysis revealed that younger individuals showed a stronger relationship between the influence of risk perception and PBC and media use on risk perception. The predictive strength of subjective norms from risk perception and risk perception from media use was more strongly associated with rural populations.

CONCLUSIONS

The results of study provide an initial understanding of the level of the public's risk perception to reduce the spread of SARS-CoV-2. Findings also revealed the role of media use in determining risk perception, attitudes and subjective norms and, in turn, change people's intention to socially distance. This study may add to the literature of behavioral changes in pandemic and provide a framework for both policymakers and practitioners to formulate effective interventions in the future.

Motivators of Indiscriminate and Unsafe Supplement Use among Young Australians

BACKGROUND

There is growing concern about the self-administration of supplements, which can often be indiscriminate, counterproductive to health, and serve as a gateway to more harmful drugs and substances. Research suggests that high uptake of performance- and image-enhancing drugs (PIEDs) is correlated with body image to accentuate masculinity. This study provides insights into limiting unhealthy supplement usage. This research identifies reasons for casual unhealthy supplement use among young adult Australians through the Theory of Planned Behavior (TPB) lens, providing practitioners with insights into developing interventions to deter their use.

METHOD

Semi-structured in-depth interviews were conducted with ten participants aged between 18 and 40, using a convenience sample. Leximancer analysis was used to assess word co-occurrence and map to TPB constructs.

RESULTS

Leximancer identified positive attitudes, social norms, and perceived behavioral control towards supplement usage. Key themes that influenced supplement use were weight loss, body image, nutrition, training, education, challenges, need, and time. Furthermore, using TPB constructs, affective and instrumental attitudes and prevailing norms were observed when investigating what would cause an individual to use supplements in an unhealthy manner.

CONCLUSION

Through understanding the motivations of indiscriminate supplement use across the Australian population, the study has uncovered several social factors that may reduce or limit the practice of unsafe supplement usage.

The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women

Objective

Cervical cancer is considered treatable as long as it is detected early and managed effectively. Pap smear test is a screening tool that plays an important role in the early detection, prevention and can prevent any early cervical cell changes from becoming cancer. This study aims to survey the effect of educational programs based on beliefs, subjective norms, and perceived behavior control on doing the pap-smear test in a sample of Iranian women.

Materials and methods

This experimental interventional study was performed on 300 women admitted to Fasa City, Fars Province, Iran health centers in 2018–2019. A questionnaire consisting of demographic information, knowledge, Health Belief Model, and Theory of Planned Behavior constructs were used to measure on doing of Pap smear test in women before and after 6 months’ educational intervention.

Results

The results revealed that 6 months after the intervention, 108 women (72%) in the experimental group and only 9 women (6%) in the control group received the Pap smear test.

Conclusions

The current research results revealed that education based on the combination of the health Belief model and theory of planned behavior might be promoting participation and an increasing rate of receiving Pap smear tests in women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01419-w.

Effects of Message Framing on Cervical Cancer Screening Knowledge and Intentions Related to Primary HPV Testing

Numerous national guidelines now include primary human papillomavirus (HPV) testing as a recommended screening option for cervical cancer in the United States yet little is known regarding screening intentions for this specific screening strategy or interventions that may increase uptake. Gain- and loss-framed messaging can positively impact health behaviors; however, there is mixed evidence on which is more effective for cervical cancer screening, with no published evidence examining HPV testing. To help address this gap, this study compared the effects of message framing on screening knowledge and intentions related to primary HPV testing. We randomized females aged 21-65 (n = 365) to receive brief messaging about cervical cancer screening with either gain- or loss-framing. In January-February 2020, participants completed pretest and posttest measures evaluating cervical cancer knowledge, beliefs, and intentions to be screened using HPV testing. We used generalized estimating equations to model message and framing effects on screening outcomes, controlling for age, education, race, and baseline measures. In comparison to pretest, messaging significantly increased HPV-related screening intentions [adjusted OR (aOR): 2.4 (1-3.5)] and knowledge [aOR: 1.7 (1.2-2.4)], perceived effectiveness of HPV testing [aOR: 4.3 (2.8-6.5)], and preference for primary HPV screening [aOR: 3.2 (1.2-8.5)], regardless of message framing. For all outcomes, no significant interaction by message framing was observed. Brief public health messaging positively impacted HPV-related screening intentions, knowledge, and beliefs, independent of message framing. In conjunction with other strategies, these results suggest that messaging could be an effective tool to increase uptake of primary HPV testing. PREVENTION RELEVANCE: Primary HPV tests are more sensitive and offer greater reassurance than Pap tests alone yet use for routine cervical cancer screening remains low. Brief public health messaging can positively impact awareness, knowledge, and screening intention regarding primary HPV testing. Messaging campaigns paired with other strategies can increase uptake across populations.See related Spotlight, p. 823.

Action Control of Colorectal Cancer Screening Participation with fecal immunochemical test (FIT)

BACKGROUND

Most of the individuals concerned by colorectal cancer screening recognize the importance of screening participation. However, the screening rates for this cancer remain low in most countries, including France. Based on the action control framework, the present study aimed to (i) explore the distribution of intentions-behavior profiles toward colorectal cancer screening and (ii) to determine to what extent the profiles could be differentiated on theory of planned behavior (TPB) (i.e., attitudes, subjective norms, perceived behavioral control [PBC]) and self-regulation variables (i.e., action planning, coping planning).

METHOD

A total of 149 participants from the general French population (M = 60 years, SD = 7.04) completed a questionnaire measuring TPB and self-regulation variables. Subsequent screening behavior was determined from medical records. Participants were notably categorized as non-intenders, unsuccessful intenders, or successful intenders. Data were analyzed using discriminant function analysis and analyses of covariance.

RESULTS

Main findings revealed that 71% of the intenders were unsuccessful intenders. TPB and self-regulation variables were significantly correlated with the discriminant function (rs ≥ .40). Successful and unsuccessful intenders reported significantly higher levels of subjective norms, PBC, and coping planning than non-intenders (ps < .01). Successful intenders reported a significantly higher level of coping planning than unsuccessful intenders (p < .01).

CONCLUSIONS

Further research appears necessary to empirically test to what extent interventions targeting subjective norms, PBC, and coping planning could enhance the proportion of successful intenders toward colorectal cancer screening.

A Model-Based Meta-Analysis of Willingness to Participate in Cancer Screening

Although early screening tests are beneficial for the detection and treatment of cancers, many people have failed to participate in screening tests. The present study aims to explore the theoretical underpinning of low participation in screening programs using the method of meta-analytic structural equation modeling. It was found that the health belief model is the most adopted theoretical framework. Moreover, the intended uptake of screening was positively predicted only by cues to action, health literacy, and perceived susceptibility. As a result, a health intention model, including the three significant variables, is proposed. The practical implications of the findings are that health communication campaigns should focus on enlightening and engaging the public through all necessary means to raise awareness and transfer knowledge in relation to screening procedures as well as cancers per se.

Evaluating the effect of an educational program on increasing cervical cancer screening behavior among women in Fasa, Iran

Background

Cervical cancer is the second most common cancer and the fifth deadliest cancer among women in Iran. Educational interventions based on the proper behavior promoting models can lead to early diagnosis of cervical cancer.This study aimed to investigate the effects of educational intervention on performing Pap smear tests based on the Theory of Planned Behavior among women living in Fasa, Iran.

Methods

A cross-sectional study was conducted on 700 participants. Thereafter, the educational intervention based on the results of cross-sectional study was conducted in a workshop form for 50 women as the intervention group and 50 women as the control group. Afterward, the data were entered into the SPSS statistical software and then analyzed via logistic regressions analysis, paired t test, independent t test, chi-square test, and McNemar test.

Result

According to the results, 45.7% of the patients had a history of performing a Pap smear test, and 20.7% of them regularly performed this test. The knowledge, attitude, subjective norms, and perceived behavioral control were the predictors of intention and behavior of Pap smear test among the women (P < 0.05). These components accounted for 57.4% and 31.6% of the intention and behavior variances, respectively. After the intervention, a significant increase was observed in the means of attitude, subjective norms, and perceived behavioral control in the intervention group compared to the control group. The results reveal no significant difference between these two groups regarding the behavioral intention (p = 0.41) and performance of the Pap smear test (p = 0.583). The number of the participants undergone the Pap smear test has increased from 10 to 26 in the intervention group by passing 3 months from the intervention. The results of McNemar test indicated that this difference was statistically significant.

Conclusion

The results indicated an increase in the women’s performance of the Pap smear screening test by appropriate planning, provision of educational packages based on the women’s needs, and using effective subjective norms.

Trial Registration: Current Controlled Trials IRCT20160830029608N3:12/31/2018. “Retrospectively registered”.

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.

Turkish and Moroccan Dutch women’s views of using a self-sampling kit for human papillomavirus testing as a tool for cervical cancer screening: What are the barriers and the motivators?

Objective:

This study explores barriers and motivators to use self-sampling kits for human papillomavirus testing for cervical cancer screening as perceived by Dutch women of Turkish and Moroccan origin living in the Netherlands.

Methods:

A total of 11 in-depth semi-structured interviews were conducted and structured according to the theory of planned behavior.

Results:

Findings suggest that self-sampling may lift important barriers hampering traditional cervical cancer screening, such as those related to shame and chastity. However, self-sampling raises its own barriers too. Most importantly, some women fear that self-sampling may harm virginity. Some women also do not feel confident about their ability to properly use the self-sampling kit, but fears about the inability to properly use it often fade away upon having seen the self-sampling kit. Moreover, results show that knowledge about cervical cancer and its origin is limited, which may undermine women’s willingness to participate in a screening program.

Conclusions:

These results suggest that communication strategies to encourage using self-sampling kits among women of Turkish and Moroccan origin could benefit from culturally sensitive approaches, for example, by placing emphasis on issues such as virginity and chastity. Consistent with a recent advice of the Health Council of the Netherlands, the kit could furthermore be sent to eligible women as a standard procedure, rather than upon request. This could reduce hassle and doubts about women’s ability to use the self-sampling kit. Finally, educating women about the importance of screening to prevent cervical cancer is needed to foster informed decision-making.

The Effectiveness of Educational Interventions on Breast Cancer Screening Uptake, Knowledge, and Beliefs among Women: A Systematic Review

There have been various systematic reviews on the significance of educational interventions as necessary components to encourage breast cancer screening (BCS) and reduce the burden of breast cancer (BC). However, only a few studies have attempted to examine these educational interventions comprehensively. This review paper aimed to systematically evaluate the effectiveness of various educational interventions in improving BCS uptake, knowledge, and beliefs among women in different parts of the world. Following the PRISMA guidelines, a comprehensive literature search on four electronic databases, specifically PubMed, Scopus, Web of Science, and ScienceDirect, was performed in May 2019. A total of 22 interventional studies were reviewed. Theory- and language-based multiple intervention strategies, which were mainly performed in community and healthcare settings, were the commonly shared characteristics of the educational interventions. Most of these studies on the effectiveness of interventions showed favorable outcomes in terms of the BCS uptake, knowledge, and beliefs among women. Educational interventions potentially increase BCS among women. The interpretation of the reported findings should be treated with caution due to the heterogeneity of the studies in terms of the characteristics of the participants, research designs, intervention strategies, and outcome measures.

Intention to Screen for Cervical Cancer Among Child Bearing Age Women in Bahir Dar City, North-West Ethiopia: Using Theory of Planned Behavior

Background

Cervical cancer screening is consistently effective in reducing the incidence and mortality rates associated with cervical cancer. However, very few women have received cervical cancer screening in the developing countries including Ethiopia. Therefore, this study aims to assess cervical cancer screening intention and its predictors among child bearing age women in Bahir Dar city, North-West Ethiopia.

Methods

A community-based cross-sectional study was conducted among 832 child bearing age women using a multistage sampling technique between March and April, 2018. Data were collected using a structured questionnaire through face-to-face interviews. Data were entered and analyzed using EpiData and SPSS version 20.0, respectively. Simple and multiple linear regression analyses were done to identify predictors of intention, and P<0.05 was used as a cutoff to determine statistical significance at multiple regressions.

Results

Eight hundred and thirty-two (98%) respondents participated in this study. The mean age of the participants was 31±SD 7.23 years, ranging from 18–49 years. The majority (61.4%) of the participants were married. The mean score of intention to receive cervical cancer screening was 10.5±2.03, with a minimum and maximum sore of 5 and 15, respectively. Four hundred and fifty-eight (55%) (95% CI=51.7–58.3) respondents scored above the mean score. Direct perceived behavioral control (β=0.19, P<0.001), direct subjective norm (β=0.06, P<0.001), direct attitude (β=0.15, P<0.001), and past screening experience (β=0.64, P<0.001) were found to be significant predictors of intention.

Conclusion

Perceived behavioral control, attitude towards the behavior, subjective norm, and past screening experience were the predictors of intention, and perceived behavioral control was the strongest predictor. Hence, behavioral change communication interventions are crucial to change their attitude and empower them to evaluate their control and normative beliefs.

Effect of Educational Program based on the Theory of Planned Behavior on Prostate Cancer Screening: A Randomized Clinical Trial

Background and Aims:

Prostate cancer screening applied for early diagnosis of prostate cancer. But it is not usually pursued by men. This study was conducted to determine the effect of educational program based on the Theory of Planned Behavior (TPB) on prostate cancer screening.

Methods:

A randomized clinical trial was carried out on 68 middle-aged men referring to community houses in Iran. Samples were selected consecutively considering the inclusion criteria. Then block randomization was used to assign the participants into two groups. Data collection included demographic characteristics, knowledge and construct of TPB (Attitude towards the behavior, Subjective norms, Perceived behavioral control, behavioral intention) and behavior. The participants in the intervention group attended a theory based program 4 session twice per week. The participants were evaluated before and two month after the intervention. P <0.05 was considered statistically significant.

Results:

After the 2 months intervention, the pretest-posttest changes in the intervention group compared to the control group were in the Knowledge 9.26 ± 3.5 vs. 0.03 ± 1.68, Attitude 11.46 ± 3.5 vs. -0.16 ± 1.39, Subjective norms 3.16 ± 2.6 vs. 0.29 ± 1.3, Behavioral control 6.76 ± 4 vs. 0.12 ± 1.60 and Behavioral intention 1.4 ± 1.54 vs. 0.00 ± 1.00 (P < 0.05). While none of the subjects in control group performed the prostate screening, 10 people (33.2%) performed it in the intervention group. (P < 0.001).

Conclusions:

Educational program based on TPB has a positive effect on prostate cancer screening. It is recommended to set up regular training programs based on TPB to encourage middle-aged men for prostate cancer screening.

Determining behavioral intention and its predictors towards cervical cancer screening among women in Gomma district, Jimma, Ethiopia: Application of the theory of planned behavior

BACKGROUND

Cervical Cancer is the leading cause of cancer-related deaths among Ethiopian women. Despite many interventions were conducted, there is low uptake of cervical cancer screening services. Also, limited evidence was available on the women's intention and its predictors towards cervical cancer screening. Therefore, this study was aimed at determining the intention and predicators of behavioral intention toward cervical cancer screening.

METHODS

A cross-sectional study was conducted in the Gomma district, Jimma, Ethiopia from August 1-30, 2019. The total sample sizes were 422 and a systematic random sampling technique was employed to select the samples. Data were collected through interviews using a structured questionnaire guide. Data were entered in epidata, and exported and analyzed using SPSS version 20.0 software. Descriptive, correlation, and multicollinearity analysis were done. Also, simple and multiple linear regression analysis were performed to identify the predictors for behavioral intention. The p-value<0.05 was used to declare a significant association.

RESULT

The response rate was 382 (90.5%). The mean age of the participants was of 26.45 (SD = 4.76). Direct attitude, subjective norm, and perceived behavioral control had a mean score of 16.78 (SD = 2.87), 15.61(SD = 1.92), and 12.86 (SD = 4.85), respectively. The intention has a mean score of 14.52 (SD = 4.01). From regression analysis, direct attitude (B = 0.346, p<0.001), direct subjective norm (B = 0.288, p = 0.008), direct perceived behavioral control (B = 0.132, p = 0.002) indirect attitude (B = 0.015, p = 0.019) and the indirect perceived behavioral control (B = 0.132, p = 0.002) were statistically significant with intention.

CONCLUSION

From this study, it was understood that women's intention towards cervical cancer screening was low. The predictors were the direct and indirect attitude, direct and indirect subjective norm, direct and indirect perceived behavioral control. This calls a need to develop strategies and take action to improve the attitude of women and their influential peoples and increase sense of control to improve their intention to screen for cervical cancer. Moreover, health care providers should have to conduct social and behavioral change communication to improve women's health seeking behavior towards cervical cancer screening applying the concept of theory of planned behavior.

Predictors of uptake of cervical cancer screening among women in Urban Tanzania: community-based cross-sectional study

OBJECTIVES

The proportion of women screened for cervical cancer in Tanzania remains small at 6-21%. Even though some studies have been conducted to address barriers, the screening uptake remains low, which denotes the presence of unidentified barriers. The main objective of this study is to assess the predictors in the uptake of cervical cancer screening (CCS) among women in Tanzania.

METHODS

This is a community-based cross-sectional study conducted to obtain quantitative data through validated questionnaires to assess predictors of CCS.

RESULTS

1013 (91.8%) of the respondents had not been screened for cervical cancer. Three predictors of CCS were identified in this study; screening intention, health beliefs, and knowledge level. 600 (54.4%) of respondents had no screening intention. 552 (50%) had negative health beliefs, and 585 (53%) had inadequate knowledge of cervical cancer and CCS. Respondents who had no intention to screen were 0.482 (AOR) times less likely to uptake CCS (P = 0.002; 95% CI: 0.305, 0.761).

CONCLUSIONS

The ongoing community-awareness raising campaigns should be coupled with community knowledge-raising campaign, and there should be an establishing of peer-supporting screening programs in communities.

Predictors of Intention to Use Maternity Waiting Home Among Pregnant Women in Bench Maji Zone, Southwest Ethiopia Using the Theory of Planned Behavior

BACKGROUND

Ending preventable maternal mortality remains an unfinished agenda and one of the world's most critical challenges. Skilled care at birth is one of the crucial strategies that help to prevent deaths that occur during delivery. Maternity waiting homes have been endorsed to facilitate access to skilled care during intra-partum and post-partum periods for women living in rural areas. However, the majority of pregnant mothers in Ethiopia do not use this service; hence, this study aimed to assess the predictors of intention to use maternity waiting home.

METHODS

A community-based cross-sectional study was conducted from March 15 to June 20, 2018 in Bench Maji Zone, Southwest Ethiopia. A multistage sampling technique was used. The data were collected by trained data collectors using a structured pre-tested questionnaire. Data were entered into the epi data manager version 4.0.2.101 and exported to SPSS version 21 for analysis. The correlation among constructs of the theory of planned behavior was estimated. A hierarchical linear regression was used to identify predictors of intention to use maternity waiting home, and α value of less than 5% was used as a level of significance.

RESULTS

A total of 829 women were interviewed. The mean age of respondents was 27.1 (±5.2) years. Thirty-nine percent of the respondents used maternity waiting home previously. The attitude (β =0.12, p<0.001), subjective norm (β =0.47, p<0.001), perceived behavioral control (β =0.42, p<0.001), and ANC use during current pregnancy (β =0.07, p=0.030) were predictors of intension to use maternity waiting homes. R square was calculated to be 81%.

CONCLUSION

The intention to use maternity waiting homes was significantly associated with antenatal care use, attitude, subjective norm, and perceived behavioral control. Thus, multidimensional interventions are important to increase the intension to use MWH.

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.

Using a Culturally Tailored Narrative to Increase Cervical Cancer Detection Among Spanish-Speaking Mexican-American Women

The objective of this study was to determine the feasibility and effectiveness of translating films, and whether the use of narrative is an effective vehicle for producing changes in knowledge, attitudes, and behaviors regarding cervical cancer compared with a nonnarrative film. A randomized controlled telephone trial surveyed the effectiveness of two films our team produced among a sample of 300 monolingual Spanish-speaking women, ages 25 to 45, who were of Mexican origin. Participants were recruited using random digit dialing (RDD) procedures from 2013 to 2014 in Los Angeles County and were randomly selected to view either a narrative or nonnarrative film. Data were collected by phone at baseline, 2 weeks, and 6 months after viewing. On average, participants arrived in the USA 25 years ago. The majority reported having less than high school education and limited English proficiency. Compared with their nonnarrative counterparts, women who received the cervical cancer-related information in the narrative film showed a significantly greater increase in new knowledge (p = 0.01) and in supportive attitudes about Pap tests expense (p = 0.05). Importantly, at 6 months, although not statistically significant, women who viewed the narrative film were also more likely to have had or scheduled a Pap test (62% vs 42%). Narratives are a useful and underutilized tool to communicate information about cancer prevention. These findings have important implications for the delivery of health education among Spanish-speaking, low-literacy immigrant women, and for the reduction of cancer-related disparities.

Application of Implementation Science to OB/GYN Quality Improvement Efforts

Although there is no shortage of guidelines and toolkits outlining clinical practices that are evidence-based and have been shown to improve outcomes, many hospitals, and L&D units struggle to figure out exactly how to implement strategies that have been shown to work. This paper will describe suggestions to help obstetrics and gynecology units successfully implement evidence-based strategies to improve quality and safety based on the theoretical framing structures of implementation science, including theories such as the Health Beliefs Model, the Theory of Planned Behavior, Ecological Perspectives, COM-B, CFIR, and tools such as Driver Diagrams.

Mental Illness and BRCA1/2 Genetic Testing Intention Among Multiethnic Women Undergoing Screening Mammography

OBJECTIVES

To examine associations between patient-reported mental illness diagnosis and symptoms and BRCA1/2 genetic testing intention among women undergoing screening mammography.

SAMPLE & SETTING

100 multiethnic women of lower socioeconomic status who were undergoing mammography screening and met family history criteria for BRCA1/2 genetic testing.

METHODS & VARIABLES

Descriptive and bivariate nonparametric statistics and multivariate logistic regression were used to examine associations between mental illness and genetic testing intention. Variables were anxiety, depression, patient-reported mental illness diagnosis and symptoms, and testing intention.

RESULTS

Prevalence rates of mental illness symptoms were 36% for clinically significant depression and 36% for anxiety. Although 76% of participants intended to undergo genetic testing, only 5% had completed testing. History of mental illness and elevated levels of anxiety and depressive symptoms were positively correlated with testing intention in the bivariate analysis. In multivariate analysis, only younger age and less education were associated with testing intention.

IMPLICATIONS FOR NURSING

Future studies should address psychosocial needs and other competing barriers at the patient, provider, and healthcare system levels to increase access to BRCA1/2 genetic testing among multiethnic women.

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.

Attitudes and referral practices for pre-exposure prophylaxis (PrEP) among HIV rapid testers and case managers in Philadelphia: A mixed methods study

Objective

Adoption of pre-exposure prophylaxis (PrEP) to prevent HIV infection has been slow. The purpose of this study was to evaluate knowledge, attitudes and referral practices for PrEP among non-prescribing providers, who may play key role.

Methods

We performed a cross-sectional survey on PrEP knowledge, attitudes, and referral practices among 66 non-prescribing HIV prevention providers (1st August to 31st December, 2016), in Philadelphia, followed by qualitative interviews with 12 of them (5th April to 10th May, 2017).

Results

Participants had a mean age of 36 years, with 62% females. Majority were HIV case managers and rapid testers. For half of the respondents, PrEP eligibility screening was part of rapid HIV testing at their organization, 40% never had PrEP training and only 27% indicated personally screening clients for eligibility. Qualitative data revealed that participants held positive attitudes about PrEP and perceived organizational support, but had concerns about potential negative impacts and barriers to routine HIV screening.

Conclusion

Results highlight the importance of training non-prescribing HIV prevention providers about PrEP, addressing their concerns, and incorporating PrEP screening and referral into routine HIV testing.

Predicting Behavioral Intentions Related to Cervical Cancer Screening Using a Three-Level Model for the TPB and SCT in Nanjing, China

: Objective: Exploring how the theory of planned behavior (TPB), social capital theory (SCT), cervical cancer knowledge (CCK), and demographic variables predict behavioral intentions (BI) related to cervical cancer screening among Chinese women.

METHODS

Self-administered questionnaires were distributed to 496 women, followed by a path analysis.

RESULTS

The three-level model was acceptable, χ²(26, 470) = 26.93, p > 0.05. Subjectively overcoming difficulties, support from significant others, screening necessity, and the objective promotion factor promoted BI, with effect sizes of 0.424, 0.354, 0.199, and 0.124. SCT and CCK promoted BI through TPB, with effect sizes of 0.262 and 0.208. Monthly income, education, age, and childbearing condition affected BI through TPB, SCT, and CCK, with effect sizes of 0.269, 0.105, 0.065, and -0.029.

CONCLUSION

The three-level model systematically predicted behavioral intentions relating to cervical cancer screening.

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.

Recognition of Consumers' Characteristics of Purchasing Farm Produce with Safety Certificates and Their Influencing Factors

In order to alleviate the situation that bad money drives out good in the produce market within the context of incomplete information, as well as bridge the gap between demand and product surplus, establishing and improving the safety certification system for farm produce is an urgent need. This paper discusses factors that affect consumers' purchase of pork with safety certificates in the setting of incomplete information. Data from 844 consumers in Jiangsu and Anhui provinces, along with a structural equation model, are adopted to study consumers' purchase intention of certified safe pork form. According to our studies, major factors refer to degree of understanding, degree of concern, recognition ability, government publicity, pork's origin information, consumers' educational levels, income levels, and consumers' evaluation of government supervision. Accordingly, suggestions are provided as follows. Above all, enhancing education and training of food safety is conducive to lead consumers' behaviors in a correct way. Next, news media and social public opinions can play a stronger role in guidance and supervision. Thirdly, an upgraded legal system should be accompanied by better policy implementation. Finally, strengthening the origin certification system and promoting a sense of brand are of significance.

Exploring motivations behind pollution-mask use in a sample of young adults in urban China

Background

Wearing a pollution mask is an effective, practical, and economic way to prevent the inhalation of dangerous particulate matter (PM). However, it is not uncommon to observe negligence in adopting such behaviour, and this especially among young segments of the population. Using the Theory of Planned Behaviour (TPB) as conceptual framework, this study explores the role of socio-cognitive factors that affect the decision of wearing a pollution mask in the context of young educated people. This is done by selecting a sample of college students in urban China, a country that has seen air quality as one of the major challenges in the last decades. While young urban college students might be expected to be receptive to standard attempts to be influenced through reason-based cognitive stimuli, it is often found that this is not the case. The empirical analysis was articulated it in two steps. Structural Equation Modelling (SEM) was first used to examine the relationships among the conceptual constructs derived from the TPB conceptual model, and second Step-Wise Ordinary Least Squares Regressions (SWOLS) were employed to observe the partial effect played by each item on the decision to wear a mask.

Results

Results show that, while reason-based stimuli play a role, attitude, social norm, and self-efficacy were the most important predictors of the behavioural intention (p < 0.01). The role of past behaviour was also acknowledged as strongly associated with the dependent variable (p < 0.01). Overall, the likelihood of wearing a pollution mask increases with the importance of others socio-cognitive and psychological factors, which could help understand behavioural biases, and explain the relative role of several mechanisms behind the decision to wear a mask.

Conclusions

While tackling pollution requires multiple and synergic approaches, encouraging self-prevention using pollution mask is a simple and effective action, implementable at negligible costs. Resistance among younger, well-educated cohorts to wear masks can be overcome by stressing the social desirability of action and the sense of empowerment derived from its usage. This study has the potential to inform policies aimed at changing suboptimal behavioural attitudes by identifying triggers for change, and it could serve in improving the tailoring of health promotion messages aimed at nudging healthy behaviour.

Electronic supplementary material

The online version of this article (10.1186/s12992-018-0441-y) contains supplementary material, which is available to authorized users.

“Taking responsibility for my health”: Health system barriers and women’s attitudes toward cervical cancer screening in Romania and Bulgaria

The study used mixed-methods to illustrate the complexity of the interplay between the contexts in Bulgaria and Romania and women’s attitudes and behaviors related to screening. A secondary analysis of quantitative data from Romanian (n = 1053) and Bulgarian (n = 1099) women and qualitative interviews ( n = 30 Romanian, n = 35 Bulgarian) was performed. Low rates of screening attendance were found in both countries. Regression analysis illustrates that attitudes and social norms significantly predicted intentions and screening behavior in both countries. Thematic analysis revealed that systemic barriers and cultural meanings were relevant to women’s decisions to attend screening or avoid contact with the health-care system.