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Sharma M, Johansen C, Batra R, Dai CL, Kapukotuwa S, Assoumou B, Batra K. Explaining the Correlates of Eating Outside-of-Home Behavior in a Nationally Representative US Sample Using the Multi-Theory Model of Health Behavior Change: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:115. [PMID: 38276809 PMCID: PMC10815807 DOI: 10.3390/ijerph21010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
Eating outside-of-home (EOH) is one of the main changes in lifestyle that occurred worldwide in the past few decades. Given that EOH behavior is influenced by individual and contextual factors, the utilization of a theory seems to be suitable in analyzing this health behavior. The fourth-generation theory multi-theory model (MTM) is designed exclusively for health behavior change at the individual and community levels. Therefore, the purpose of this analytical cross-sectional study was to investigate EOH behavior by using the MTM among a nationally representative sample in the United States (US). Data for this study were collected from April-May 2023 via a 61-item psychometric valid, web-based, structured survey disseminated via Qualtrics. Chi-square/Fisher's exact tests were used to compare categorical data, whereas the independent-samples t-test was used to compare the mean scores of MTM constructs across groups. Pearson correlation analysis was performed for the intercorrelation matrix between the MTM constructs and hierarchical regression models were built to predict the variance in the initiation and sustenance by certain predictor variables beyond demographic characteristics. The p values in the multiple comparisons were calculated by using adjusted residuals. Among a total of 532 survey respondents, 397 (74.6%) indicated being engaged in EOH at least twice a week, whereas 135 (25.4%) reported not being engaged in EOH. People who were engaged in EOH were younger (mean age = 42.25 ± 17.78 years vs. 55.89 ± 19.43 years) African American, (15.9% vs. 6.7%, p = 0.01), single or never married, (34.0% vs. 23.0%, p = 0.02), had a graduate degree (9.6% vs. 3.7%, p = 0.03), and were employed (72.0% vs. 34.8%, p < 0.001) as opposed to those who reported not being engaged in eating outside the home. Among the MTM constructs of initiation, "behavioral confidence" and "changes in the physical environment" were the significant predictors of initiating a reduction in EOH behavior and explained 48% of the variance in initiation. Among the MTM constructs of sustenance, "emotional transformation" and "changes in the social environment" were the significant predictors of sustaining a reduction in EOH behavior and explained 50% of the variance in sustenance. This study highlights a need to design MTM-based educational interventions that promote in-home eating instead of frequent EOH for health, family bonding, economic, and other reasons.
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Affiliation(s)
- Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA; (M.S.); (C.J.); (S.K.)
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Christopher Johansen
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA; (M.S.); (C.J.); (S.K.)
| | - Ravi Batra
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
| | - Chia-Liang Dai
- Department of Teaching and Learning, College of Education, University of Nevada, Las Vegas, NV 89154, USA;
| | - Sidath Kapukotuwa
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA; (M.S.); (C.J.); (S.K.)
| | - Bertille Assoumou
- Department of Surgery, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Kavita Batra
- Office of Research, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
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Sharma M, Johansen C, Batra K, Dai CL, Batra R, Hayes T, Singh A. Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain the Seeking of Stool-Based Tests for Colorectal Cancer Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6553. [PMID: 37623139 PMCID: PMC10454677 DOI: 10.3390/ijerph20166553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
Colorectal cancer is the third most common cancer worldwide and is the second leading cause of cancer-associated deaths. While colorectal cancer is on the decline in the United States (US), disparities still exist, despite the non-invasive screening modalities, such as stool-based tests have shown themselves to be effective in the detection of colorectal cancer. Many of the existing stool-based test interventions lack the use of a contemporary theory-based approach. Given the paucity of theory-based interventions intended to promote stool-based tests, this cross-sectional study utilizes the multi-theory model (MTM) of health behavior change to explain the seeking of stool-based tests for colorectal cancer (CRC) screening. An online 57-item questionnaire with an established psychometric validity was used to collect responses from the US-based sample (n = 640) of adults aged 45-75 years old. The data were analyzed using bivariate and multivariate statistical methods. Structural equation modeling (SEM) was conducted to test the construct validity of the survey instrument. In this nationwide sample, 39.2% (n = 251) of participants reported having received some form of a stool-based test. Among the participants who did not undergo stool-based CRC screening, the MTM subscales, including "participatory dialogue", "behavioral confidence", and "changes in the social environment", were significant predictors of initiating screening behavior and explained 48% of the variance in the initiation among this group (R2 = 0.579, F = 5.916, p < 0.001; adjusted R2 = 0.481). The MTM may be a useful framework with which to design educational, mass media, social media, and clinical interventions for the promotion of stool-based CRC screening among adults aged 45-75 years old.
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Affiliation(s)
- Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA;
| | - Christopher Johansen
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
| | - Kavita Batra
- Office of Research, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA
- Department of Medical Education, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA
| | - Chia-Liang Dai
- Department of Teaching and Learning, College of Education, University of Nevada, Las Vegas, NV 89102, USA;
| | - Ravi Batra
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
| | - Traci Hayes
- Department of Public Health, School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA;
| | - Aditi Singh
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA;
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Sharma M, Batra K, Chen CC, Dai CL, Batra R, Cappelli DP. Predicting Flossing through the Application of the Multi-Theory Model (MTM) of Health Behavior Change among Minority Adolescents in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15106. [PMID: 36429824 PMCID: PMC9690246 DOI: 10.3390/ijerph192215106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/03/2022] [Accepted: 11/12/2022] [Indexed: 06/16/2023]
Abstract
Adolescents from minority groups are particularly susceptible to poor oral hygiene behaviors, including lack of daily flossing. This cross-sectional study aimed to conduct an exploratory behavioral research to identify evidence-based (theory-based) approaches to promote flossing behavior among African American/Black and Latinx/Hispanic (minority) adolescents. A 39-item psychometrically valid web-based questionnaire was used to collect responses from a nationwide sample of minority adolescents aged 10-17 years residing in the United States. The data were analyzed using bivariate and multivariate statistical methods. Of 520 minority adolescents (260 African American/Black and 260 Latinx/Hispanic adolescents), the proportion of flossing was nearly equally split in the sample. A significantly higher proportion of minority adolescents who were flossing had access to floss as opposed to those who were not flossing (86.8% vs. 69.8%, p < 0.001). A significantly higher proportion of minority adolescents who were not flossing did not visit the dentist over the past year as opposed to those who floss (25.2% vs. 14.7%, p < 0.001). Among the participants who were not flossing, gender, grade level, instruction in school regarding flossing, and multi-theory model (MTM) of health behavior change constructs were the significant predictors (p < 0.001) of initiating and sustaining flossing. The findings of this study will serve as baseline data for developing and evaluating effective evidence-based interventions using the MTM.
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Affiliation(s)
- Manoj Sharma
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
- Office of Research, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Ching-Chen Chen
- Department of Counselor Education, School Psychology, and Human Services, College of Education, University of Nevada, Las Vegas, NV 89154, USA
| | - Chia-Liang Dai
- Department of Teaching and Learning, College of Education, University of Nevada, Las Vegas, NV 89154, USA
| | - Ravi Batra
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
- Department of Information Technology, Coforge Ltd., Atlanta, GA 30338, USA
| | - David P. Cappelli
- School of Dental Medicine, University of Nevada, Las Vegas, NV 89102, USA
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Sharma M, Batra K, Wilkerson AH, Chirico F, Raich S. A multi-theory model based analysis of correlates for initiating and sustaining mammography screening behavior among Hispanic American women in the United States. Health Promot Perspect 2022; 12:110-119. [PMID: 35854851 PMCID: PMC9277286 DOI: 10.34172/hpp.2022.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Despite the known advantages of mammography, screening rates among Hispanic American women are lower compared to other ethnic groups. Therefore, this cross-sectional study aimed to explore correlates of mammography screening behavior among a sample of Hispanic women aged 45-54 years living in the United States using the multi-theory model (MTM). Methods: A 50-item web-based survey consisting of psychometrically valid tools based on MTM theoretical framework was administered through non-random sampling procedures using Qualtrics. Univariate, bivariate, and multivariate statistics were used to analyze the data. Results: Out of 370 participants, nearly 49% (n=189) reported not having a mammogram in the past two years. The mean age of the sample was 48.8±2.8 years. A greater proportion of participants who have had a mammogram reported having health insurance compared to those who have not had a mammogram (93.1% vs. 75.7%, P <0.001). Results of hierarchical regression suggest that all MTM constructs, including participatory dialogue, behavioral confidence, and changes in the physical environment explained 33.4% of variance in initiating mammography behavior among those who have not had a mammogram. Similarly, practice for change, emotional transformation, and changes in the social environment explained 53% of the variance in sustenance of the behavior change. Conclusion: Along with the MTM subscales, this study points to the important correlates such as health insurance and messaging by healthcare providers to promote the mammography seeking behavior among Hispanic women.
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Affiliation(s)
- Manoj Sharma
- Department of Social & Behavioral Health, School of Public Health, University of Nevada, Las Vegas, USA
| | - Kavita Batra
- UNLV Medicine Trauma and Critical Care, Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, USA
| | | | - Francesco Chirico
- Università Cattolica del Sacro Cuore, Post-Graduate Specialization, Rome, Italy
| | - Siddharth Raich
- Department of Social & Behavioral Health, School of Public Health, University of Nevada, Las Vegas, USA
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Vallone F, Lemmo D, Martino ML, Donizzetti AR, Freda MF, Palumbo F, Lorenzo E, D'Argenzio A, Caso D. Factors Promoting Breast, Cervical and Colorectal Cancer Screenings participation: A Systematic Review. Psychooncology 2022; 31:1435-1447. [PMID: 35793430 PMCID: PMC9541457 DOI: 10.1002/pon.5997] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/05/2022]
Abstract
Objective The present study aims at systematically reviewing research conducted on factors promoting breast, cervical and colorectal cancer screenings participation. Methods A literature search in MEDLINE/PubMed and PsycInfo from January 2017 to October 2021 was performed. Data extraction, researchers' full agreement and the inclusion criteria produced 102 eligible studies. Data were narratively synthesized and critically interpreted. Results Multiple factors favoring or hindering breast, cervical and colorectal cancer screenings were identified and summarized as factors operating at the individual level (background information, individual characteristics, emotions related to screening procedure and to cancer, knowledge and awareness), at the relational level (relationships with healthcare staff, significant others, community members), and at the healthcare system level (systems barriers/policy, lack of staff). A critical appraisal of studies revealed a fragmentation in the literature, with a compartmentalization of studies by type of cancer screening, country and specific populations of destination. Conclusions Overall findings indicated that greater integration of research results obtained independently for each cancer diagnosis and within the different countries/populations could foster a more comprehensive understanding of factors potentially enhancing the participation in breast, cervical and colorectal cancer screenings worldwide. This review, which is grounded in the current context of globalization and superdiversification in population, can help to enhance a better integration between research and practices, by supporting the development of more effective and inclusive evidence‐based interventions and health‐promotion campaigns worldwide. Research and practical implications are highlighted and discussed.
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Affiliation(s)
- Federica Vallone
- University of Naples Federico II, Department of Humanities, Napoli, Italy.,Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Napoli, Italy
| | - Daniela Lemmo
- University of Naples Federico II, Department of Humanities, Napoli, Italy
| | | | | | | | - Francesco Palumbo
- Department of Political Sciences, University of Naples Federico II, Napoli, Italy
| | - Elvira Lorenzo
- Regione Campania, Direzione Generale per la Tutela della Salute ed il Coordinamento del Sistema Sanitario Regionale, Napoli, Italy
| | - Angelo D'Argenzio
- Regione Campania, Direzione Generale per la Tutela della Salute ed il Coordinamento del Sistema Sanitario Regionale, Napoli, Italy
| | - Daniela Caso
- University of Naples Federico II, Department of Humanities, Napoli, Italy
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Explaining Correlates of Cervical Cancer Screening among Minority Women in the United States. PHARMACY 2022; 10:pharmacy10010030. [PMID: 35202079 PMCID: PMC8875364 DOI: 10.3390/pharmacy10010030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/01/2022] [Accepted: 02/12/2022] [Indexed: 12/09/2022] Open
Abstract
Globally, cervical cancer is the fourth leading cause of death among women. While overall cervical cancer rates have decreased over the last few decades, minority women continue to be disproportionately affected compared to White women. Given the paucity of theory-based interventions to promote Pap smear tests among minority women, this cross-sectional study attempts to examine the correlates of cervical cancer screening by Pap test using the Multi-theory Model (MTM) as a theoretical paradigm among minority women in the United States (U.S.). Structural Equation Modelling (SEM) was done for testing the construct validity of the survey instrument. Data were analyzed through bivariate and multivariate tests. In a sample of 364 minority women, nearly 31% (n = 112) of women reported not having received a Pap test within the past three years compared to the national rate (20.8%) for all women. The MTM constructs of participatory dialogue, behavioral confidence, and changes in the physical environment explained a substantial proportion of variance (49.5%) in starting the behavior of getting Pap tests, while the constructs of emotional transformation, practice for change, and changes in the social environment, along with lack of health insurance and annual household income of less than $25,000, significantly explained the variance (73.6%) of the likelihood to sustain the Pap test behavior of getting it every three years. Among those who have had a Pap smear (n = 252), healthcare insurance, emotional transformation, practice for change, and changes in the social environment predicted nearly 83.3% of the variance in sustaining Pap smear test uptake behavior (adjusted R2 = 0.833, F = 45.254, p < 0.001). This study validates the need for health promotion interventions based on MTM to be implemented to address the disparities of lower cervical cancer screenings among minority women.
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