An application of an extended health belief model to the prediction of breast self-examination among women with a family history of breast cancer
Corresponding Author
Paul Norman
Institute of Medical Genetics, University of Wales College of Medicine, Cardiff, UK
Correspondence should be addressed to Dr Paul Norman, Department of Psychology, University of Sheffield, Sheffield, S10 2TP, UK (e-mail: [email protected]).Search for more papers by this authorKate Brain
Institute of Medical Genetics, University of Wales College of Medicine, Cardiff, UK
Search for more papers by this authorCorresponding Author
Paul Norman
Institute of Medical Genetics, University of Wales College of Medicine, Cardiff, UK
Correspondence should be addressed to Dr Paul Norman, Department of Psychology, University of Sheffield, Sheffield, S10 2TP, UK (e-mail: [email protected]).Search for more papers by this authorKate Brain
Institute of Medical Genetics, University of Wales College of Medicine, Cardiff, UK
Search for more papers by this authorAbstract
Objectives. This study reports an application of the health belief model (HBM) to the prediction of breast self-examination (BSE) among women with a family history of breast cancer. The study also considered the influence of breast cancer worries and past behaviour.
Methods. Eight hundred and thirty-three women completed questionnaires, based on the HBM, to assess their beliefs about breast cancer and BSE. Of these women, 567 were followed-up at 9 months when BSE frequency was assessed.
Results. Discriminant function analysis was employed to discriminate among infrequent, appropriate and excessive BSE. Two functions were calculated which were predictive of group membership. The first function maximally discriminated between the infrequent BSE group and the other two groups, with infrequent self-examiners reporting a greater number of self-efficacy and emotion barriers, fewer benefits and less frequent BSE at Time 1. The second function maximally discriminated between the excessive BSE group and the appropriate BSE group, with excessive self-examiners reporting higher levels of breast cancer worries and perceived severity and fewer self-efficacy barriers.
Conclusions. The results highlight the importance of focusing on excessive as well as infrequent BSE. Interventions designed to enhance women's confidence in their ability to perform BSE, coupled with attempts to reduce breast cancer worries, may encourage more appropriate and effective BSE.
References
-
Ajzen, I.
Attitudes, personality and behavior Milton Keynes Open University Press 1988.
10.1148/radiology.166.3.3340772 Google Scholar
- Ajzen, I. The theory of planned behavior. Organizational Behavior and Human Decision Processes 50 179–211 1991.
- Alagna, S. W. Morokoff, P. J. Bevett, J. M. Reddy, D. M. Performance of breast self-examination by women at high risk for breast cancer. Women and Health 12 29–46 1987.
- Alagna, S. W. Reddy, D. M. Predictors of proficient technique and successful lesion detection in breast self-examination. Health Psychology 3 113–127 1984.
- American Cancer Society (2004). Can breast cancer be found early? Retrieved 5 August 2004 from American Cancer Society Website: http:www.cancer.orgdocrootCRIcontentCRI_2_4_3X_Can_breast_cancer_be_found_early_5.asp.
- Austoker, J. Be breast aware London Department of Health and NHS Breast Screening Programme 1991.
- Austoker, J. Breast self-examination: Does not prevent deaths due to breast cancer, but breast awareness is still important. British Medical Journal 326 1–2 2003.
- Bandura, A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review 84 191–215 1977.
- Bandura, A. Social foundations of thought and action: A cognitive social theory Englewood Cliffs, NJ Prentice-Hall 1986.
- Baxter, N. Preventive health care, 2001 update: Should women be routinely taught breast self-examination to screen for breast cancer?. Canadian Medical Association Journal 164 1837–1846 2001.
- Becker, M. H. The health belief model and sick role behavior. Health Education Monographs 2 409–419 1974.
- Brain, K. Norman, P. Gray, J. Mansel, R. Anxiety and adherence to breast self-examination in women with a family history of breast cancer. Psychosomatic Medicine 61 181–187 1999.
- Brain, K. Gray, J. Norman, P. France, E. Anglim, C. Barton, G. Parsons, E. Clarke, A. Sweetland, H. Branston, L. Sampson, J. Roberts, E. Newcombe, R. Cohen, D. Rogers, C. Mansel, R. Harper, P. A randomised trial of a specialist genetic assessment service for familial breast cancer. Journal of the National Cancer Institute 92 1345–1351 2000.
- Brett, J. Austoker, J. Evaluation of breast awareness training resource pack for primary care nurses: Final report Oxford Cancer Research Campaign 1999.
- Calnan, M. Rutter, D. R. Do health beliefs predict health behaviour? An analysis of breast self-examination. Social Science and Medicine 22 673–678 1986.
- Chalmers, K. I. Luker, K. A. Breast self-care practices in women with primary relatives with breast cancer. Journal of Advanced Nursing 23 1212–1220 1996.
- Champion, V. L. Instrument development of the health belief model constructs. Advances in Nursing Science 6 73–85 1984.
- Champion, V. L. Use of health belief model in determining frequency of self-breast exam. Research in Nursing and Health 8 373–382 1985.
- Champion, V. L. The relationship of breast self-examination to health belief model variables. Research in Nursing and Health 10 375–382 1987.
- Champion, V. L. Attitudinal variables related to intention, frequency and proficiency of breast self-examination in women 35 and over. Research in Nursing and Health 11 283–291 1988.
- Champion, V. L. Effect of knowledge, teaching method, confidence and social influence on breast self-examination behavior. Journal of Nursing Scholarship 21 76–80 1989.
- Champion, V. L. Breast self-examination in women 35 and older: A prospective study. Journal of Behavioral Medicine 13 523–538 1990.
- Conner, M. Armitage, C. Extending the theory of planned behavior: A review and avenues for further research. Journal of Applied Social Psychology 28 1429–1464 1998.
- Craun, A. M. Deffenbacher, J. L. The effects of information, behavioral rehearsal, and prompting on breast self-exams. Journal of Behavioral Medicine 10 351–365 1987.
- Drossaert, C. H. C. Boer, H. Seydel, E. R. 2003 Prospective study of the determinants of repeat attendance patterns in breast cancer screening using the theory of planned behaviour. Psychology and Health 18 551 – 565.
- Eagly, A. H. Chaiken, S. The psychology of attitudes Fort Worth, TX Harcourt Brace Jovanovich 1993.
- Epstein, R. J. Breast self examination provides entry strategy. British Medical Journal 326 710 2003.
- Epstein, S. A. Bertell, R. Seaman, B. Dangers and unreliability of mammography: Breast examination is a safe, effective, and practical alternative. International Journal of Health Services 31 605–615 2001.
- Epstein, S. A. Lerman, C. Excessive health behaviors in those at risk for physical disorder. Journal of Psychosomatic Research 43 223–225 1997.
- Epstein, S. A. Lin, T. H. Audrain, J. Stefanek, M. Rimer, B. Lerman, C. Excessive breast self-examination among first-degree relatives of newly diagnosed breast cancer patients. Psychosomatics 38 253–261 1997.
- Fallowfield, L. J. Rodway, A. Baum, M. What are the psychological factors influencing attendance and non-attendance at a breast screening centre?. Journal of the Royal Society of Medicine 83 547–551 1990.
- Frank, J. W. Mai, V. Breast self-examination: More harm than good?. Lancet 2 654–657 1985.
- Friedman, L. C. Nelson, D. V. Webb, J. A. Hoffman, L. P. Baer, P. E. Dispositional optimism, self-efficacy and health beliefs as predictors of breast self-examination. American Journal of Preventive Medicine 10 130–135 1994.
- Fung, S. Y. Factors associated with breast self-examination behavior among Chinese women in Hong Kong. Patient Education and Counseling 33 233–243 1998.
- Hallal, J. The relationship of health beliefs, health locus of control, and self-concept to the practice of breast self-examination in adult women. Nursing Research 31 137–142 1982.
- Harrison, J. A. Mullen, P. D. Green, L. W. A meta-analysis of studies of the health belief model with adults. Health Education Research 7 107–116 1992.
- Harvey, B. J. Miller, A. B. Baines, C. J. Corey, P. N. Effect of breast self-examination techniques on the risk of death from breast cancer. Canadian Medical Association Journal 157 1205–1212 1997.
-
Heimann, R. Bradley, J. Hellman, S.
The benefits of mammography are not limited to women aged older than fifty years.
Cancer
82 2221–2226 1988.
10.1002/(SICI)1097-0142(19980601)82:11<2221::AID-CNCR17>3.0.CO;2-W PubMedWeb of Science®Google Scholar
- Janz, N. K. Becker, M. H. The health belief model: A decade later. Health Education Quarterly 11 1–47 1984.
- Kash, K. M. Holland, J. C. Halper, M. S. Miller, D. G. Psychological distress and surveillance behaviors of women with a family history of breast cancer. Journal of the National Cancer Institute 84 24–30 1992.
- Koibuchi, Y. Iino, Y. Takei, H. Maemura, M. Horiguchi, J. Yokoe, T. Morishita, Y. The effect of mass screening by physical examination combined with regular breast self examination on clinical stage and course of Japanese women with breast cancer. Oncology Reports 5 151–155 1998.
- Lerman, C. Kash, K. Stefanek, M. Younger women at increased risk for breast cancer: Perceived risk, psychological well-being, and surveillance behavior. Journal of the National Cancer Institute Monographs 16 171–176 1994.
- Lerman, C. Lustbader, E. Rimer, B. Daly, M. Miller, S. Sands, C. Balshem, A. Effects of individualized breast cancer risk counseling: A randomized trial. Journal of the National Cancer Institute 87 286–291 1995.
- Lerman, C. Trock, B. Rimer, B. K. Jepson, C. Brody, D. Boyce, A. Psychological side effects of breast cancer screening. Health Psychology 10 259–267 1991.
- Luszczynska, A. Schwarzer, R. Planning and self-efficacy in the adoption and maintenance of breast self-examination: A longitudinal study on self-regulatory cognitions. Psychology and Health 18 93–108 2003.
- Manasciewicz, R. Editorial misses central point. British Medical Journal 326 710 2003.
- Massey, V. Perceived susceptibility to breast cancer and practice of breast self-examination. Nursing Research 35 183–185 1986.
- McCaul, K. D. Schroeder, D. M. Reid, P. A. Breast cancer worry and screening: Some prospective data. Health Psychology 15 430–433 1996.
- Moore, P. Excessive breast self-examination may promote anxiety. Lancet 353 1073 1999.
- Mullen, P. D. Hersey, J. C. Iverson, D. C. Health behavior models compared. Social Science and Medicine 24 973–983 1987.
- Murray, M. McMillan, C. Health beliefs, locus of control, emotional control and women's cancer screening behaviour. British Journal of Clinical Psychology 32 87–100 1993.
- Norman, P. Conner, M. The role of social cognition models in predicting health behaviours: Future directions M. Conner P. Norman Predicting health behavior 197–225 Buckingham Open University Press 1996.
- Norman, P. Searle, A. Harrad, R. Vedhara, K. Predicting adherence to eye patching in children with amblyopia: An application of protection motivation theory. British Journal of Health Psychology 8 67–82 2003.
- Orbell, S. Hodgkins, S. Sheeran, P. Implementation intentions and the theory of planned behavior. Personality and Social Psychology Bulletin 23 945–954 1997.
- Ouellette, J. Wood, W. Habit and intention in everyday life: The multiple processes by which past behavior predicts future behavior. Psychological Bulletin 124 54–74 1998.
-
Owens, R. G. Daly, J. Heron, K. Lemster, S. J.
Psychological and social characteristics of attenders for breast screening.
Psychology and Health
1 303–313 1987.
10.1080/08870448708400333 Google Scholar
- Quine, L. Rutter, D. R. Arnold, L. Predicting and understanding safety helmet use among schoolboy cyclists: A comparison of the theory of planned behaviour and the health belief model. Psychology and Health 13 251–269 1998.
- Ronis, D. L. Kaiser, M. K. Correlates of breast self-examination in a sample of college women: Analyses of linear structural relations. Journal of Applied Social Psychology 19 1068–1084 1989.
-
Ronis, D. L. Harel, Y.
Health beliefs and breast self-examination behaviours: Analysis of linear structural relations.
Psychology and Health
3 259–285 1989.
10.1080/08870448908400385 Google Scholar
- Rosenstock, I. M. Strecher, V. J. Becker, H. M. Social learning theory and the health belief model. Health Education Quarterly 15 175–183 1988.
- Rutledge, D. N. Davis, G. T. Breast self examination compliance and the health belief model. Oncology Nursing Forum 15 175–179 1988.
- Sattin, R. W. Rubin, G. L. Webster, I. A. Family history of the risk of breast cancer. Journal of the American Medical Association 253 1908–1913 1985.
- Schwarzer, R. Fuchs, R. Self-efficacy and health behaviour M. Conner P. Norman Predicting health behavior 163–196 Buckingham Open University Press 1996.
- Sheeran, P. Abraham, C. The health belief model M. Conner P. Norman Predicting health behavior 23–61 Buckingham Open University Press 1996.
- Smith, R. A. Breast self examination: Do we really know what we think we know?. British Medical Journal USA 3 168–169 2003.
- Steel, C. M. Cohen, B. Porter, D. Familial breast cancer. Seminal Cancer Biology 3 141–150 1992.
- Stefanek, M. E. Wilcox, P. First-degree relatives of breast cancer patients: Screening practices and provision of risk information. Cancer Detection and Prevention 15 379–384 1991.
- Stefanek, M. E. Wilcox, P. Huelskamp, A. Breast self-examination proficiency and training effects: Women at increased risk of breast cancer. Cancer, Epidemiology, Biomarkers and Prevention 1 591–596 1992.
- Tabachnick, B. G. Fidell, L. S. Using multivariate statistics 3rd ed New York Harper Collins 1996.
- Thomas, D. B. Gao, D. L. Ray, R. M. Wang, W. W. Allison, C. J. Chen, F. L. Porter, P. Hu, Y. W. Zhao, G. L. Pan, L. D. Li, W. J. Wu, C. Y. Coriaty, Z. Evans, I. Lin, M. G. Stalsberg, H. Self, S. G. Randomized trial of breast self-examination in Shanghai: Final results. Journal of the National Cancer Institute 94 1445–1457 2002.
- Vaionio, H. Bianchini, F. Breast cancer screening Lyon IARC Press 2002.