HEALTH BELIEFS ON THE BEHAVIORAL ADOPTION OF MAMMOGRAPHY SCREENING MODERATED BY KNOWLEDGE AND MARITAL STATUS: A PATH ANALYTIC MODEL
Keywords:Breast cancer, Mammography, Health behavior, Health belief model, Structural equation modeling
Despite the effectiveness of mammography for early breast cancer detection, its’ utilization among Malaysian women remains low. Health beliefs are closely related to health screening behavior. Hence, it is important that health beliefs are employed when exploring mammography screening behavior. Thus, the study utilized HBM constructs in predicting the variance in adoptive behavior of mammography. A multi-stage, stratified random sampling method was utilized to select the polyclinics in Kuantan, Pahang. Using sample size calculation at 5% type 1 error, p < 0.05 and absolute error at 2%, 520 Malaysian women aged 35 to 70 years were randomly selected. Sets of copyrighted, validated questionnaire were used to obtain the data. Structural equation modeling using Mplus was used to test the model. All health beliefs were found to significantly influence the behavioral adoption of mammography screening. Socio-demographic factors (married women) were found to moderate significantly the relationship between perceived susceptibility and behavioral adoption of mammography. Further, knowledge and married women were found to significantly affect self-efficacy. Additionally, perceived severity, motivator factors and perceived benefits were found to significantly influence self-efficacy and that self-efficacy significantly influences the behavioral adoption of mammography screening. However, a negative correlation was found between perceived severity and perceived barriers on the behavioral adoption of mammography. The model can be used as an interventional tool in designing promotional and educational programs to encourage women to adopt mammography screening.
Lim GCC, Rampal S, Yahaya H. Cancer Incidence in Peninsular Malaysia, 2003-2005. The Third Report of the National Cancer Registry, Malaysia. Kuala Lumpur: National Cancer Registry, Malaysia. 2008.
Dahlui M, Ramli S, Bulgiba AM. Breast cancer prevention and control programs in Malaysia. Asian Pac J Cancer Prev 2011;12:1-4.
Ministry of Health Malaysia. Malaysia National Cancer Registry Report 2012-2016. Putrajaya, Malaysia: National Cancer Institute.
Griva F, Anagnostopoulos F, Gourounti K, et al. Mammography screening within the context of the theory of planned behavior: The role of personality traits and personal factors. Int J Psychol Stud 2013;5(3):98-107.
Abdelaziz SH, Youssef NF, Abdel N, et al. Factors associated with mammography screening behaviors: A cross-sectional descriptive study of Egyptian women. International Journal of Medical and Health Sciences 2015;9(5):401-7
Mirzaei-Alavijeh M, Ghorbani P, Jalilian F. Socio-cognitive determinants of the mammography screening uptake among Iranian women. Asian Pac J Cancer Prev 2018;19(5):1351-5.
Assi HA, Khoury KE, Dbouk H, et al. Epidemiology and prognosis of breast cancer in young women. J Thorac Dis. 2013;5 Suppl 1(Suppl 1):S2-S8.
Seely JM, Alhassan T. Screening for breast cancer in 2018—What should we be doing today? Curr Oncol 2018;25(S1):S115-24.
Mahmud A, Aljunid SM. The uptake of mammogram screening in Malaysia and its associated factors: A systematic review. Med J Malaysia 2018b;73(4):202-11.
Foundation for Promotion of Cancer Research. International comparisons of cancer mortality and cancer screening rates. Cancer statistics in Japan 2009, 2009.
Hirai K, Harada K, Seki A, et al. Structural equation modeling for implementation intentions, cancer worry, and stages of mammography adoption. Psycho-Oncology 2013;22:2339-46.
Yip CH, Smith RA, Anderson BO, et al. Guideline Implementation for breast healthcare in low- and middle-income countries. Cancer 2008;113:2244-56.
Anderson BO, Cazap E, Saghir NSE, et al. Optimization of breast cancer management in low- resource and middle- resource countries: executive summary of the Breast Health Global Initiative consensus, 2010. Lancet Oncol 2011;12:387-98.
Yusof A, Chia YC, Hasni YM. Awareness and prevalence of mammography screening and its predictors--a cross sectional study in a primary care clinic in Malaysia. Asian Pac J Cancer Prev 2014;15(19):8095-9.
Kanaga K, Nithiya J, Shatirah N. Awareness of breast cancer and screening procedures among Malaysian women. Asian Pac J Cancer Prev 2011;12:1965-7.
Mahmud A, Aljunid SM. Availability and accessibility of subsidized mammogram screening program in peninsular Malaysia: A preliminary study using travel impedance approach. PLoS One 2018a;13:e0191764.
Patel K, Kanu M, Liu J, et al. Factors influencing breast cancer screening in low-income African Americans in Tennessee. J Community Health 2014;39(5):943–950.
Allahverdipour H, Asghari-Jafarabadi M, Emami A. Breast cancer risk perception, benefits of and barriers to mammography adherence among a group of Iranian women. Women Health 2011;51:204-19.
Mamdouh H, El-Mansy H, Kharboush I, et al. Barriers to breast cancer screening among a sample of Egyptian females. J Fam Community Med 2014;21(2):119–24.
Taymoori P, Berry T, Roshani D. Differences in Health Beliefs Across Stage of Adoption of Mammography in Iranian Women. Cancer Nurs 2014;37(3): 208–217.
Alexandraki I, Mooradian AD. Barriers Related to Mammography Use for Breast Cancer Screening Among Minority Women. J Natl Med Assoc 2010;102(3): 206–218.
Valastyan S, Weinberg R. Tumor Metastasis: Molecular Insights and Evolving Paradigms. Cell 2011;147(2): 275-292.
Sun Y, Zhao Z, Yang Z, et al. Risk Factors and Preventions of Breast Cancer. Int J Biol Sci 2017;13(11): 1387-1397.
Sohl SJ, Moyer A. Tailored interventions to promote mammography screening: A meta-analytic review. Prev Med 2007;45(4):252-61.
Institute of Medicine. Speaking of Health: Assessing Health Communication Strategies for Diverse Populations. Washington, DC: The National Academies Press 2002:28-75.
Murphy CC, Vernon SW, Diamond PM, et al. Competitive testing of health behavior theories: how do benefits, barriers, subjective norm, and intention influence mammography behavior? Ann Behav Med 2014;47(1):120-9.
Spencer L, Pagell F, Adams T. Applying the transtheoretical model to cancer screening behavior. Am J Health Behav 2005;29(1):36-56.
Russell KM, Monahan P, Wagle A, et al. Differences in health and cultural beliefs by stage of mammography screening adoption in African American women. Cancer 2007;109(2 Suppl):386-95.
Juanita J, Jittanoon P, Boonyasopun U. BSE Practice and BSE Self-Efficacy among Nursing Students in Aceh, Indonesia. Nurse Media J Nurs 2013;3(1):557-568.
Chukmaitov A, Wan TTH, Menachemi N, et al. Breast cancer knowledge and attitudes toward mammography as predictors of breast cancer preventive behavior in Kazakh, Korean, and Russian women in Kazakhstan. Int J Public Health 2008;53:123-30.
Barbeau K, Boileau K, Sarr F, et al. Path analysis in Mplus: A tutorial using a conceptual model of psychological and behavioral antecedents of bulimic symptoms in young adults. Quant Meth Psych 2019;15(1):38-53.
Hu L-t, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling 1999;6(1):1-55.
Wang J, Wang X. Structural equation modeling: applications using Mplus. 2nd ed. United Kingdom: John Wiley & Sons Ltd 2012.
Fedak KM, Bernal A, Capshaw ZA et al. Applying the Bradford Hill criteria in the 21st century: how data integration has changed causal inference in molecular epidemiology. Emerg Themes Epidemiol 2015;12(14).
Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach, Guilford Press. New York, NY. 2013.
Perez LG, Elder JP, Haughton J, et al. Socio-demographic Moderators of Associations between Psychological Factors and Latinas' Breast Cancer Screening Behaviors. J Immigr Minor Health 2018;20(4):823–830.
Ramli HA, Moey SF, Mutalib AMA. The relationship of health beliefs on the stage of mammography behavior adoption amongst women in Kuantan, Pahang. Asian Pac J Cancer Prev 2019;20(6):1913-20.
Wu TY, Hsieh HF, West BT. Demographics and perceptions of barriers toward breast cancer screening among Asian-American women. Women Health 2008;48(3):261-81.
Donnelly TT, Al-Khater AH, Al-Bader SB, et al. Beliefs and attitudes about breast cancer and screening practices among Arab women living in Qatar: A cross-sectional study. BMC Womens Health 2013;13:49.
Gierisch JM, Earp JA, Brewer NT, et al. Longitudinal predictors of nonadherence to maintenance of mammography. Cancer Epidemiol Biomarkers Prev 2010;19(4):1103-11.
Glanz K, Rimer BK, Viswanath K. Health Behavior and Health Education: Theory, Research, and Practice. 4th ed. United Kingdom: John Wiley & Sons 2008.
Shirzadi S, Allahverdipour H, Sharma M, et al. Perceived barriers to mammography adoption among women in Iran: A qualitative study. Korean J Fam Med 2020;41:20-7.
Moodi M, Rezaeian M, Mostafavi F, et al. Determinants of mammography screening behavior in Iranian women: A population-based study. J Res Med Sci 2012;17(8):750-9.
Dündar PE, Özmen D, Öztürk B, et al. The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in western Turkey. BMC Cancer 2006;6(43):1-9.
Ahmadian M, Samah AA. Application of health behavior theories to breast cancer screening among Asian women. Asian Pac J Cancer Prev 2013;14(7):4005-13.
Rosmawati NHN. The usage and knowledge of mammogram among women in sub-urban area in Terengganu, Malaysia. Asian Pac J Cancer Prev 2010;11:767-71.
Al-Naggar RA, Bobryshev YV. Practice and barriers of mammography among Malaysian women in the general population. Asian Pac J Cancer Prev 2012;13:3595-3600.
Swapana M, Padmavathy C. A critical review on breast cancer literature: Screening, awareness and preventive measures. Mediterr J Soc Sci 2015;6(4):256-63.
Luszczynska A, Schwarzer R. Planning and self-efficacy in the adoption and maintenance of breast self-examination: A longitudinal study on self-regulatory cognitions. Psychol Health 2003;18(1):93-108.
Roh S, Burnette CE, Lee YS, et al. Breast cancer literacy and health beliefs related to breast cancer screening among American Indian women. Soc Work Health Care 2018;57:465-82.
Secginli S. Mammography self-efficacy scale and breast cancer fear scale: Psychometric testing of the Turkish versions. Cancer Nurs 2012;35(5):365-73.
Bonsu AB, Ncama BP. Recognizing and appraising symptoms of breast cancer as a reason for delayed presentation in Ghanaian women: A qualitative study. PLoS One 2019;14(1):1-21.
Al-Dubai SAR, Qureshi AM, Saif-Ali R, et al. Awareness and knowledge of breast cancer and mammography among a group of Malaysian women in Shah Alam. Asian Pac J Cancer Prev 2011;12:2531-8.
Sambanje MN, Mafuvadze B. Breast cancer knowledge and awareness among university students in Angola. Pan Afr Med J 2012;11:70.
Noreen M, Murad S, Furqan M, et al. Knowledge and awareness about breast cancer and its early symptoms among medical and non-medical students of Southern Punjab, Pakistan. Asian Pac J Cancer Prev 2015;16(3):979-84.
Diab S, Wahdan I, Gawwad EA, et al. Mammography screening utilization behavior among Egyptian female employees in Alexandria. Journal of High Institute of Public Health 2018;48(2):114-24.
Frost J. How To Interpret R-squared in Regression Analysis. Available at: https://statisticsbyjim.com/regression/interpret-r-squared-regression/. (Accessed December 7, 2019).