The effect of message framing on breast self-examination attitudes, intentions, and behavior

In this study we tested the framing hypothesis that a pamphlet stressing the negative consequences of not performing breast self-examination (BSE) would be more persuasive than a pamphlet emphasizing BSE's positive consequences. College-aged female subjects were exposed to a loss-frame pamphlet, a gain-frame pamphlet, or a no-arguments pamphlet, or they received no pamphlet describing the importance of and the techniques for performing BSE. Attitudes toward BSE and intentions to perform BSE were assessed immediately after this intervention and again 4 months later. The follow-up also assessed subjects' postexperimental BSE behavior. Consistent with predictions, subjects who read a pamphlet with arguments framed in loss language manifested more positive BSE attitudes, intentions, and behaviors than did subjects in the other three conditions. The greater impact of the loss pamphlet could not be attributed to greater fear arousal, better memory for pamphlet content, greater perceived susceptibility to breast cancer, or stronger beliefs in BSE's efficacy on the part of the loss subjects. Only measures of perceived self-efficacy in performing BSE were differentially affected by the framing manipulation, with loss subjects reporting the greatest levels of self-confidence. The results are discussed in terms of prospect theory's framing postulate and a simpler negativity-bias conceptualization, and underlying mechanisms such as differential salience and vividness are considered. Clinical implications of the findings are also explored.     

The Theory of Planned Behavior and Breast Self-Examination: Distinguishing Between Perceived Control and Self-Efficacy

This paper reports an application of the theory of planned behavior (TPB) to the prediction of breast self-examination (BSE) intentions and behavior. The study also considered the distinction between perceived control and self-efficacy within the TPB and the additional predictive utility of past behavior. A sample of 95 women completed questionnaires based on the TPB and were followed up at 1 month. Support for the distinction between perceived control and self-efficacy was provided by principal components analysis. The TPB was found to be highly predictive of intention to perform BSE and subsequent BSE behavior. Regression analyses revealed self-efficacy and attitude to be predictive of intention to perform BSE. Intention, in turn, was the sole predictor of BSE at 1-month follow-up. Past behavior was found to explain additional variance in intention, but not BSE behavior at 1-month follow-up. The results are discussed in relation to the conceptual status of the perceived behavioral control construct, and the practical implications of the results are highlighted.     

The Impact of Breast Cancer Genetic Risk Assessment on Intentions to Perform Cancer Surveillance Behaviors

One hundred and fifty-four women undergoing breast/ovarian cancer genetic risk assessment completed questionnaires at entry into the Cancer Genetic Service for Wales (CGSW) assessment program and following risk provision, mapping the strength of intentions to engage in a number of preventive/surveillance behaviors, including seeing specialists, breast self-examination, and involvement in screening programs, including mammography. A number of potential predictors of intentions were also assessed, including participants' mood and emotional response to receiving risk information, the perceived benefits (in terms of reassurance and early disease detection) of engaging in each preventive behavior, and the perceived desires of their family and General Practitioner. Intentions to self-examine did not change following risk provision, although strength of intentions to engage in some other preventive behaviors did lessen. Family and General Practitioners appeared to be strong social influences on behavioral intentions, as were the perceived benefits of gaining reassurance and/or early detection of disease.     

Predictors of proficient technique and successful lesion detection in breast self-examination

Seventy-three women attending a health fair completed a questionnaire that measured demographic and health history variables, knowledge, and current practice of breast self-examination (BSE), Multidimensional Health Locus of Control (MHLC; Wallston, Wallston, & DeVellis, 1978), and components of the Health Belief Model (HBM; Rosenstock, 1974) in relation to breast cancer and BSE. These variables formed the basis of a conceptual model of BSE behavior that was examined by having each woman participate in a behavioral trial with a breast model in which her BSE technique and ability to detect simulated tumors was assessed. Regression analyses revealed that self-confidence in the efficacy of BSE was the best single predictor of proficient BSE. Powerful others HLC, knowledge of correct BSE behaviors, and chance HLC, respectively, also contributed significantly to the variance in performance. As anticipated, successful lesion detection was most strongly associated with more proficient BSE technique and higher frequency of BSE practice in the past six months. Internal HLC scores were not predictive of either behavioral measure. Similarly, except for perceived efficacy of BSE, HBM variables showed no strong relationships to observed behavior.     

Can the effectiveness of health promotion campaigns be improved using self-efficacy and self-affirmation interventions? An analysis of sun protection messages

Health-risk communications frequently target self-efficacy in order to encourage adaptive responses. Research has also indicated that self-affirmation may be a useful supplementary or alternative intervention technique. This study compared the effects of self-efficacy, self-affirmation and a combination of these techniques for two risk messages. Young British females (N=677) read about ultraviolet light and skin cancer or skin ageing ('photoageing') and were randomly assigned to a single intervention (self-affirmation/self-efficacy), the combined intervention or no intervention. The efficacy intervention led to greater message acceptance and perceived risk in both the cancer and photoageing conditions, while the only main effect of self-affirmation was on acceptance of the photoageing message. However, self-affirmation moderated the effect of efficacy information. For photoageing messages, efficacy information was associated with greater message acceptance only amongst self-affirmed participants, but the opposite occurred for skin cancer messages. Although these findings should be interpreted cautiously, they imply that health promoters should select efficacy information if only one intervention is used but that self-affirmation can influence responsiveness to efficacy interventions for particular messages.     

Can the effectiveness of health promotion campaigns be improved using self-efficacy and self-affirmation interventions? An analysis of sun protection messages

Health-risk communications frequently target self-efficacy in order to encourage adaptive responses. Research has also indicated that self-affirmation may be a useful supplementary or alternative intervention technique. This study compared the effects of self-efficacy, self-affirmation and a combination of these techniques for two risk messages. Young British females (N?=?677) read about ultraviolet light and skin cancer or skin ageing (‘photoageing’) and were randomly assigned to a single intervention (self-affirmation/self-efficacy), the combined intervention or no intervention. The efficacy intervention led to greater message acceptance and perceived risk in both the cancer and photoageing conditions, while the only main effect of self-affirmation was on acceptance of the photoageing message. However, self-affirmation moderated the effect of efficacy information. For photoageing messages, efficacy information was associated with greater message acceptance only amongst self-affirmed participants, but the opposite occurred for skin cancer messages. Although these findings should be interpreted cautiously, they imply that health promoters should select efficacy information if only one intervention is used but that self-affirmation can influence responsiveness to efficacy interventions for particular messages.     

Cancer Genetics Service Interest in Women with a Limited Family History of Breast Cancer

Women with a limited family history of breast cancer may be interested in cancer genetics information although their objective risk of breast cancer may not indicate routine referral to cancer genetics services. This study examined factors related to interest and use of cancer genetics services in a community sample of women with a limited family history of breast cancer (N = 187) who had no previous contact with cancer genetics services. Participants provided demographic information and ratings of perceived risk, cancer distress, attitudes, and intentions to initiate cancer genetics services. Participants were given information about a cancer genetics clinic that served women having concerns about their breast cancer risk. Women were contacted within 6 weeks and 8 months following their study appointment. Six weeks following their study appointment, 25% of women had initiated cancer genetics services. Eight months following their study appointment, 18% of women reported having completed a cancer genetics service appointment. Baseline intentions independently predicted both initiation at 6 weeks and appointment at 8 months. Cancer distress was positively associated with cancer genetics service initiation and appointment. Results suggest that some women with a limited family history of breast cancer are interested in seeking out cancer genetics information. Women with a limited family history of breast cancer may benefit from the availability of cancer genetics information provided through primary healthcare settings.     

Cancer Worry,Perceived Risk and Cancer Screening in First-Degree Relatives of Patients with Familial Gastric Cancer

Currently, there is a lack of evidence evaluating the psychological impact of cancer-related risk perception and worry in individuals at high risk for gastric cancer. We examined the relationships between perceived risk, cancer worry and screening behaviors among first-degree relatives (FDRs) of patients with familial gastric cancer. FDRs of patients diagnosed with familial gastric cancer with a non-informative genetic analysis were identified and contacted. Participants completed a telephone interview that assessed socio-demographic information, cancer risk perception, cancer worry, impact of worry on daily functioning, and screening behaviors. Twenty-five FDRs completed the telephone interview. Participants reported high levels of comparative and absolute cancer risk perception, with an average perceived lifetime risk of 54 %. On the other hand, cancer-related worry scores were low, with a significant minority (12 %) experiencing high levels of worry. Study participants exhibited high levels of confidence (median = 70 %) in the effectiveness of screening at detecting a curable cancer. Participants that had undergone screening in the past showed significantly lower levels of cancer-related worry compared to those that had never undergone screening. In conclusion, individuals at high-risk for gastric cancer perceived a very high personal risk of cancer, but reported low levels of cancer worry. This paradoxical result may be attributed to participants’ high levels of confidence in the effectiveness of screening. These findings highlight the importance for clinicians to discuss realistic risk appraisals and expectations towards screening with unaffected members of families at risk for gastric cancer, in an effort to help mitigate anxiety and help with coping.     

A Test of the Theory of Planned Behavior for Two Health-Related Practices1

This study tested the utility of the theory of planned behavior in predicting two health-related behaviors. The first behavior (breast self-exam) is relatively simple, while the second (exercise) is complex. Data were utilized from health risk appraisals completed on 185 telephone company employees. Attitude, normative belief, and self-efficacy measures served to predict behavioral intention and subsequent attempt to change both the behaviors. As tested in path models, the results for breast self-examination were closer to the results expected from theory, with less good fit for exercise. Different models were developed for each behavior, although the self-efficacy measures made independent contributions to each. While the theory of planned behavior received support in the data, the results suggest that different models may appropriate for different types of behavior.     

Posttraumatic Stress Among Women With Breast Cancer and Their Daughters: Relationship With Daughters' Breast Cancer Screening

Cancer-related posttraumatic stress (PTS) in women with breast cancer, perceived risk of cancer in these women's daughters, and daughters' PTS related to their mothers' breast cancer were tested for relationships to daughters' breast self-examination (BSE) and mammography activity. Daughters' mammography frequency was related to her own PTS, but not to her perceived risk or her mothers' PTS. In contrast, daughters who overperformed BSE had mothers reporting significantly greater PTS than those performing BSE at recommended rates or underperforming BSE. Daughters' BSE and mammography frequency were not correlated. Differing demands related to BSE and mammography, and their relationship to different distress variables are discussed.     

Health Promotion,Health Locus of Control,and Health Behavior: Two Field Experiments1

In spite of a sizable body of research on the effects of information promotions on health knowledge and health behavior, relatively little is known about how such efforts affect change (or why they do not). This paper addresses that problem by exploring the particular role that health locus of control (HLC) beliefs play in individual responses to health promotion efforts aimed at encouraging preventive health behaviors. Two field experiments are presented. The first experiment examined the extent to which HLC beliefs are related to differences in individual levels of health knowledge following the distribution of an informational booklet on health. Internals high on health value who received the information booklet demonstrated greater health knowledge three months later than did other subjects, although this difference was greater among men than among women. The second experiment explored how HLC beliefs interact with differently framed “control” messages to promote behavior change in breast self-examination (BSE). HLC beliefs interacted with the control language of the BSE promotional message and a neutral reminder to affect subsequent BSE practice. Together, these studies suggest a more influential role for health locus of control beliefs in shaping responses to health messages than has previously been documented in field settings.     

Health Beliefs and Illness Perceptions as Related to Mammography Uptake in Randomly Selected Women in Greece

Previous research has shown that, although routine mammography screening can reduce mortality from breast cancer, the use of annual mammography screening remains well under 65%. In an effort to determine the factors that are associated with women’s mammography behaviors, this study used the health belief model and the common-sense model of self-regulation as the theoretical frameworks to explore health beliefs, illness representations, and women’s mammography practice. Data were obtained from a nationally representative sample of 408 Greek women, 40 years of age or older, with no personal history of cancer. Three dependent variables were considered: recent mammography, repeat mammography, and no mammogram during lifetime. Predictors included socio-demographic and medical variables, perceived benefits of mammography screening, perceived barriers to mammography screening, self-efficacy, as well as illness perceptions. Multivariate analyzes indicated that never having had a mammogram was more likely for women who perceived fewer benefits and more barriers to mammography screening, had more negative emotional representations of breast cancer, and had no private health insurance coverage. Factors associated with recent mammography were younger age, a good knowledge of the recommended mammography screening interval, a family history of breast cancer, and use of patient reminders for next mammogram. Adequate knowledge about the recommended mammography screening interval and higher values for breast cancer worry were associated with an increased number of repeat lifetime mammograms. Implications of the results and suggestions for future research are outlined.     

Examining the Influence of Self-Efficacy on Message-Framing Effects: Reducing Salt Consumption in the General Population

Health-promoting messages can be framed in terms of the gains associated with healthy behavior or the losses associated with unhealthy behavior. Studies show inconsistent results as to which type of framing is more effective. In this study, we investigated whether participants' self-efficacy to decrease salt intake would moderate the effects of gain- and loss-framed messages promoting a low-salt diet on information acceptance, intention, and behavior. We hypothesized that loss-framed messages would more effectively decrease salt intake than gain-framed messages, but only when participants had high self-efficacy. A total of 575 adults, recruited from an Internet panel, took part in the study. Half of the participants received self-efficacy enhancing information, whereas the other half received no such information. After this self-efficacy manipulation, half of the participants received a gain-framed and half of the participants received a loss-framed message promoting a low-salt diet. Information acceptance and intention were assessed at immediate posttest and salt consumption was assessed at a 3-week follow-up. The results revealed the hypothesized effect on behavior. However, the interaction between self-efficacy and framing on salt consumption was not mediated by measures of information acceptance and intention to reduce salt intake. Our results suggest that messages stressing losses may be more effective than messages stressing gains in decreasing salt intake but only in persons with high self-efficacy to do so.     

Effects of Contract Framing,Motivation to Quit,and Self-Efficacy on Smoking Reduction1

Social learning theorists (SLT) have advocated that individual's cognitive beliefs about perceived behavioral ability and outcome expectancies are predictive of behavior change. SLT's also propose that the threat of losing positive rewards may result in greater behavior change than gaining rewards for altering behaviors such as smoking. Specifically, presenting behavioral outcomes in a loss frame context has proven more influential under certain conditions than presenting outcomes in a gain frame context. The present study evaluated the relationship between smoking cessation self-efficacy motivation to quit, and contract framing on smoking reduction. The majority of cognitive and behavioral changes occurred between baseline and 3 months into a 12-month treatment program. An interaction between contract framing and motivation to quit suggested that, for subjects with low motivation, receiving combined (gain plus loss) frame contracts resulted in smoking fewer cigarettes posttreatment than receiving gain frame only contracts. An interaction between framing and self-efficacy also indicated that subjects who received combined frame contracts smoked fewer cigarettes if they had high rather than low self-efficacy beliefs.     

Awareness,Perceptions, and Provider Recommendation Related to Genetic Testing for Hereditary Breast Cancer Risk among At-Risk Hispanic Women: Similarities and Variations by Sub-Ethnicity

This study explored awareness of risk factors for hereditary breast and ovarian cancer (HBOC), awareness, knowledge and concerns about genetic testing, and preference for how to have genetic testing recommended by a care provider among at-risk Hispanic women. Differences in these factors among Mexican, Cuban, and Puerto Rican women were also examined. Women with a personal or family history of breast or ovarian cancer from the Tampa Bay Area participated in a qualitative interview (N = 53). Data were analyzed using a combination of open and axial coding with a grounded theory approach. Study participants in all groups reported: being aware that family history was a breast cancer risk factor, limited knowledge of genetic testing, fear of test results, concerns about children’s risks, and no physician referral for genetic testing. Noteworthy sub-ethnic differences included preferences for physician recommendation and information about genetic testing. This study provides important preliminary information about areas related to HBOC that require additional education in the Hispanic community as a whole and by sub-ethnicity.     

Participation in Breast Cancer Genetic Counseling: The Influence of Educational Level, Ethnic Background, and Risk Perception

Genetic counseling has been suggested as a means of providing information and support to women with a family history of breast cancer. Yet women who undergo cancer genetic counseling in the United States generally consist of only a subset of those at risk, namely well-educated, upper-middle class, European American and Jewish women. We report outcomes from a study that provided a unique opportunity to determine whether women of African American, European American, Native American, or Ashkenazi Jewish ancestry have varying interest in having cancer genetic counseling. The study offered a genetic counseling session to 97 women with a family history of breast cancer who were participating in a larger interview study designed to assess attitudes toward genetic testing for breast cancer. The study offered genetic counseling free of charge to all study participants with a family history of breast cancer, removing the potential barriers of cost, the need for a physician referral, and lack of awareness of genetic counseling. Fifty women out of the 97 women offered genetic counseling (52%) accepted the offer by completing a session. Those who accepted genetic counseling had a higher educational level, a higher perceived risk of breast cancer, and were more likely to expect a positive BRCA1 or BRCA2 genetic test if they were to undergo genetic testing. When controlling for education level, there was no correlation between the participants' ethnic background and acceptance of a genetic counseling session. Outreach efforts to minority populations may increase awareness of the availability of genetic counseling and may facilitate participation by such populations.     

An investigation of preconditions necessary for the introduction of a campaign to promote breast self-examination amongst Zimbabwean women

This study examines elements of the health belief model as predictors of intentions to self-examine breasts in two samples of women. Undergraduate samples from London and Harare are compared on levels of knowledge of breast cancer and breast self-examination (BSE), and on scales measuring perceived susceptibility to breast cancer, exposure to information and experience of breast cancer and perceived costs, barriers and benefits of BSE. Analysis of results indicates that an education campaign to promote awareness and the practice of BSE which incorporates factors of the health belief model could increase the number of Zimbabwean women performing this valuable preventive health behaviour.     

Cancer Family History Reporting: Impact of Method and Psychosocial Factors

Family history is one the greatest risk factors for disease and one of the most important informational tools in medical genetics for the purpose of diagnosis, risk assessment, prevention and treatment. However, research is needed on the comparability of different methods of cancer family history assessment and the influence of psychosocial factors in family history reports. The purpose of this study was to determine if individuals had discrepancies between written and interview reports of cancer family history and the role of psychosocial factors in these discrepancies. Oncology patients (n=104) were administered a survey to assess psychosocial factors (i.e., information-seeking, worry, perceived risk, and health literacy) and were asked to provide family history in a written and an interview form. Randomization determined which form individuals received first. No differences in the amount of missing data or the amount of unspecified data were noted between the written and interview method. Psychosocial factors did not differentiate between those who had discrepancies in family history reports and those who did not have discrepancies in family history reports; although there was a trend for those with lower literacy and those who were blunters to be more discrepant on type of cancer diagnosis. In sum, this preliminary study indicates that written and interview methods of family history assessment for first degree relatives may be used interchangeably. The ability to use written methods will facilitate collection of basic family history information in the oncology clinic.     

Being at risk for cardiovascular disease: perceptions and preventive behavior in people with and without a known genetic predisposition

This study compares and explains differences in perceptions of cardiovascular disease (CVD) risk and preventive behaviors in people with and without a known genetic predisposition to CVD. A cross-sectional study using two samples was performed. The first sample (genetic predisposition; n?=?51) consisted of individuals recently diagnosed with familial hypercholesterolemia (FH) through DNA testing. The second sample (no genetic predisposition; n?=?49) was recruited among patients with CVD-risk profiles based on family history of CVD, cholesterol levels, and blood pressure, registered at general practices. Participants filled out a postal questionnaire asking about their perceived risk, causal attributions (i.e. genetic and lifestyle), and about perceived efficacy and adoption of preventive behavior (i.e. medication adherence and adoption of a healthy diet and being sufficiently active). Perceived comparative risk, genetic attributions of CVD, and perceived efficacy of medication were higher in the "genetic predisposition" sample than in the "no genetic predisposition" sample. The samples did not differ on lifestyle attributions, efficacy of a healthy lifestyle, or preventive behavior. Individual differences in perceived risk, genetic attributions, perceived efficacy of medication, and adoption of a healthy lifestyle were best explained by family history of CVD. Our findings suggest that in people diagnosed with a single gene disorder characterized by a family disease history such as FH, family disease history may be more important than DNA information in explaining perceptions of and responses to risk.