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.     

Religiosity and Cancer Screening

Churches have been suggested as avenues to reach African-American populations with messages about health because of their strong participation in church activities. Membership in several religious denominations has been associated with healthy lifestyle practices that are associated with lower cancer-incidence rates and better coping strategies among cancer patients. Among African-American women, however, belief in God as their doctor might preempt seeking treatment for cancer. The goal of the present study was to examine the influence of church participation and religious beliefs on the utilization of breast and cervical cancer screening among low-income, predominantly African-American women. A cohort consisting of 290 women was surveyed at baseline and one year later to determine the association between screening rates in the past year and measures of religiosity. The majority of women were members of a church (88%), with fairly regular church attendance (51% reported weekly attendance), and strong beliefs regarding God's influence on their health (e.g. 88% agreed that God was their doctor). Church attendance was the only religious variable related to screening frequency in univariate analyses, with those reporting attending church 1–3 times per month more likely to receive mammography screening (p = .013). Churches can provide avenues to reach African-American women about cancer screening; strong religious beliefs do not, however, appear to keep women from receiving regular screening exams.     

The utility of socio-demographics,knowledge and health belief model variables in predicting reattendance for mammography screening: A brief report

Abstract

The aims of the present study were to investigate socio-demographic and knowledge variables as predictors of re attendance for mammography screening and to examine the utility of the Health Belief Model (HBM) in predicting reattendance for mammography screening above and beyond socio-demographic and knowledge variables. A total of 88 reattenders and 44 non-reattenders of an Australian breast screening service completed a questionnaire assessing socio-demographics (age, marital status, education, physician recommendation and family history), knowledge and HBM variables. Results showed that reattenders were more likely to be older, married and report physician involvement than non-reattenders. Family history and knowledge did not significantly predict reattendance. Of the HBM variables, perceived benefits was related to reattendance above and beyond socio-demographics. Results support the utility of the HBM as a focus for improving regular attendance for breast screening. It is concluded that non-reattenders should be investigated as a seperate group to women who have never attended for mammography screening.     

The Impact of Breast Cancer Knowledge and Attitudes on Screening and Early Detection Among an Immigrant Iranian Population in Southern California

Few studies explored factors influencing breast cancer screening and early detection behaviors among immigrant Iranian women residing in the USA. Using a cross-sectional survey, a convenience sample of 319 Iranian American women was selected to investigate the impact of breast cancer knowledge and attitude on screening. A self-administered questionnaire assessed breast cancer screening knowledge, attitude, and mammography use (ever, previous year, and future intention). 79 % of the women in the study reported ever receiving at least one mammogram and 74 % received a mammogram in the past year. Personal attitude had an independent significant effect on: mammography use in the last year, ever use of mammography, and future intention to screen. Knowledge and morality-induced attitude influenced screening behavior but not significantly. Interventions targeting breast cancer screening among immigrant Iranian women in the USA should focus on enhancing personal attitudes in order to influence actual screening behavior.     

Prospective Study on the Determinants of Repeat Attendance and Attendance Patterns in Breast Cancer Screening Using the Theory of Planned Behaviour

This prospective study, using the Theory of Planned Behaviour (TPB) as a theoretical framework, was carried out to identify the determinants of repeat attendance and attendance patterns in organised breast screening. A group of 2657 women filled out a baseline questionnaire, approximately 8 weeks after having been invited for an initial screening in the Dutch Breast Cancer Screening Programme. Data on actual attendance in second and third screening round were subsequently collected. Personal variables such as family history of breast cancer, breast cancer in someone close and fear of breast cancer were not related to repeat attendance. The TPB variables could explain approximately 17% of the variance in attendance in the second and third round. Maintenance behaviour (consistent attendance vs. dropout) was related to the TPB variables, but the amount of variance explained was only 6%. Initiation of behaviour (consistent refusal vs. delayed attendance) also was related to TPB variables, with a substantially higher amount of explained variance than with maintenance behaviour. Results indicate that the TPB variables are more related to the initiation of screening behaviour than to the maintenance of screening behaviour. Implications of these findings for breast cancer screening are discussed.     

Influence of Church Attendance and Spirituality in a Randomized Controlled Trial to Increase Mammography Use Among a Low-Income, Tri-Racial, Rural Community

Background The influence of church attendance and spirituality on mammography use was studied among Native American, White, and African American women living in a rural county. Methods A randomized trial was conducted to increase mammography use. Women (n = 851) were randomly assigned to receive either an educational program delivered by a lay health advisor or a physician letter and brochure about cervical cancer screening (control group). Church attendance and spirituality were measured at baseline and mammography use was evaluated 12 months after enrollment using medical record review. Results Almost two-thirds of the women reported that they attended church at least once a week, and less than 4% were classified as having low spirituality. Church attendance (P = 0.299) or spirituality (P = 0.401) did not have a significant impact on mammography use. Conclusions Church attendance and spirituality did not impact mammography use.     

The Relationship Between Religious Coping Style and Anxiety over Breast Cancer in African American Women

In this study, we investigated the relationship between religious coping style and anxiety related to breast cancer and the use of mammography in a sample of African American women. We also assessed the relationship of breast cancer anxiety to related variables such as church affiliation and attendance, church teachings on health, and acceptance of those teachings.     

Are Religious Women More Likely to Have Breast Cancer Screening?

The study objective was to investigate whether women who frequently attend religious services are more likely to have breast cancer screening—mammography and clinical breast examinations—than other women. Multivariate logistic regression models show that white women who attended religious services frequently had more than twice the odds of breast cancer screening than white women who attended less frequently (Odds Ratio (OR) = 2.61; 95% Confidence Interval (CI) = 1.12, 6.06). The behavior of white women was different from African American women (religious attendance-race interaction term p-value = 0.008); African American women who attended religious services frequently were possibly less likely to have breast cancer screening (OR 0.49; CI = 0.19–1.31).     

How can We Reduce the Distress Associated with Health Screening? From Psychological Theory to Clinical Practice

Health screening involves the early identification of risk factors for disease or early‐stage disease. There is clear evidence of a health benefit following many screening programs. However, these programs may also contribute to significant psychological distress in a significant minority of vulnerable individuals. This paper considers the impact of screening in relation to breast cancer, focusing on assessment of genetic risk for breast cancer and mammography. It then reviews how these programs presently try to minimize any distress among participants before examining how health and clinical psychological theory can contribute to the development of new interventions, focusing on the use of cognitive challenge and teaching appropriate emotion‐focused coping strategies such as mindfulness and distraction. Future research developments are then addressed.     

Jewish identity and intentions to obtain breast cancer screening

This study explored the associations between 2 dimensions of Jewish identity (cultural identification and religious practice) and intentions to perform breast cancer screening. Ashkenazi Jewish women (N = 220) completed surveys as part of an ongoing study of breast cancer risk counseling. Multiple regressions examined the relationships between the 2 identity measures and intention to follow routine recommendations for mammography, intention to perform monthly breast self-exam, and interest in genetic testing for breast cancer susceptibility. Cultural identity positively predicted interest in testing, whereas religious identity was inversely related. Religious identity was a significant predictor of intention to adhere to mammography recommendations. Findings show that culture and religion, although correlated, may have different associations with health attitudes.     

Distress, personality, and mammography utilization among women with a family history of breast cancer.

The authors examined the impact of psychological distress and the personality construct of conscientiousness (as measured by the Neuroticism, Extraversion, and Openness-Five Factor Inventory) on mammography utilization among women who were at increased risk for breast cancer. Participants were 200 women who had at least 1 first degree relative with breast cancer. Overall, 80% of the participants had obtained a mammogram in the previous year. Analyses controlling for potential confounders (perceived risk, decisional balance, and physician recommendation for mammography), revealed that distress was negatively associated with mammography utilization among participants who were low in conscientiousness. Distress was not significantly related to mammography utilization among highly conscientious women. The results are discussed in terms of their implications regarding interventions designed to increase mammography utilization in this population.     

Busy lifestyles and mammography screening: Time pressure and women’s reattendance likelihood

Time pressure is often cited as a reason for non-attendance at mammography screening, although evidence from other areas of psychology suggests that time pressure can improve performance when barriers such as time pressure provide a challenge. We predicted that time pressure would negatively predict attendance in women whose self-efficacy for overcoming time pressure is low, but positively predict attendance when self-efficacy is high. Time pressure was operationalised as the self-reported number of dependent children and others, and average number of working hours per week. Australian women were surveyed after being invited to attend second or subsequent screenings at a free public screening service, and subsequent attendance monitored until six months after screening was due. The majority (87.5%) attended screening. Women with more dependent children and higher self-efficacy showed greater attendance likelihood, and women with fewer non-child dependants and lower self-efficacy were less likely to attend. Working hours did not predict attendance. Findings provide partial support for the idea that time pressure acts as a challenge for women with high self-efficacy.     

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.     

A Mobile Colonoscopic Unit for Lynch Syndrome: Trends in Surveillance Uptake and Patient Experiences of Screening in a Developing Country

The Genetic and Endoscopic Surveillance Clinic is an annual outreach service offering accessible colonoscopic surveillance to known families with Lynch syndrome living in remote areas of the Western and Northern Cape Province of South Africa. Unfortunately attendance at this outreach clinic has been declining over several years and fewer than a quarter of participants, attending for surveillance, have been adherent with all their recommended screening appointments. Concerns exist for non-adherent individuals as screening can prevent colorectal cancer by removing the precancerous lesion or enabling the treatment of a malignancy at an early stage. This study explored the experience of surveillance from both the non-adherers’ and adherers’ perspectives and identified unique factors affecting attendance at the outreach clinic. Rates of compliance are calculated for 191 mutation-positive cases of Lynch syndrome, using strict attendance criteria, and compared to figures obtained from self-reported attendance. Non-compliance was under-reported and compliance was exaggerated when basing data on self-reported adherence to recommendations. Specific characteristics of the outreach clinic affecting compliance are identified and recommendations are made to facilitate improvements to the service. These improvements can result in increased compliance with screening regimens and ultimately reduce cancer-related mortality.     

The influence of coping styles on mammography screening in a multiethnic sample

A total of 308 women from seven ethnic subpopulations (comprising major ethnic groups of Black, Hispanic, and non-Hispanic White) were interviewed to examine their coping styles in response to an imagined breast cancer diagnosis and to determine relationships among ethnicity, access to mammography, coping styles, and mammography screening. There were ethnic subpopulation differences in the five coping styles identified (problem solving, social support, positive reframing, wishful thinking, and avoidance), and in the relations between screening rates and coping styles. Specifically, ethnicity differentially moderated the relationship between screening rates and avoidance within and between major groups. Researchers studying behavior that is likely to be impacted by culture, such as health preventive behaviors, are well advised to take coping styles into account, as well as to examine potential ethnic subpopulation differences.     

The Effects of a State-Wide Media Campaign on Mammography Screening1

A media campaign was constructed to promote mammography screening in North Dakota. The media included radio and newspaper advertisements that emphasized personal vulnerability to breast cancer. Persons in northern North Dakota were exposed to the ads; persons in southern North Dakota were not. Surveys conducted after the campaign showed that intervention women were aware of the ads. A state-wide longitudinal survey (N= 383) also suggested that the campaign may have influenced women who had been screened previously to have a repeat screening. However, the ads may have adversely affected those women who had never been screened. We discuss comparisons between media attempts and other strategies that can potentially influence health behavior in rural areas.     

Relationship of social support and social burden to repeated breast cancer screening in the women's health initiative.

Direct and interactive effects of social support, social burden (caregiving, negative life events, and social strain), education, and income on repeated use of breast cancer screening among a large (N=55,278), national sample of postmenopausal women participating in the Women's Health Initiative observational study were examined. Repeated screening decreased as emotional/informational support and positive social interactions decreased (ps<.01). Repeated mammography decreased with frequent caregiving (p<.01). Less social strain reduced the frequency of repeated breast self-examinations (BSEs; ps<.01), but frequent caregiving and more negative life events increased repeated use of BSE (ps<.01). Interactive effects suggested that emotional/informational but not tangible support is associated with repeated mammography and clinical breast examinations (ps<.01) and may be particularly important among low-income older women, especially those burdened by caregiving.     

Incorporation of a successful community-based mammography intervention: dissemination beyond a community trial.

Although a variety of interventions to increase breast cancer screening have been found to be effective in community-based trials, their ultimate contribution depends on the extent to which they are incorporated (i.e., adopted and adapted) by community organizations. From 1990 to 1995, the authors conducted a National Cancer Institute-funded community-based trial that increased screening mammography among women ages 40 and older living in Minneapolis public housing. This study describes the processes by which this intervention, called Friend to Friend, was successfully adopted by the American Cancer Society, Midwest Division, and adapted for use by women throughout the state. The authors offer insights from experience with this translational effort and make recommendations to facilitate collaboration between research and community organizations.     

Psychosocial Conditions of Women Awaiting Genetic Counseling: A Population-based Study

The decision whether to undergo genetic counseling for hereditary breast and ovarian cancer is complex. Knowledge about the psychosocial conditions of women who are awaiting counseling is sparse. We aimed to compare the psychosocial conditions of women awaiting genetic counseling with those of women in two reference groups. We included 567 women referred to genetic counseling for hereditary risk of breast or ovarian cancer (Genetic Group), 689 women referred to mammography (Mammography Group) and a random sample of 2,000 women from the general population (Population Group). One to 4 weeks before the first counseling session or mammography, data were collected by questionnaires. Both women affected with cancer and unaffected women in the Genetic Group appeared to have a somewhat higher prevalence of cancer-specific-distress than the corresponding reference groups. Further research on the effect of pre- counseling interventions appear warranted in addition with exploring a potential association between waiting time and cancer-specific distress.     

The Doctor is Just a Messenger: Beliefs of Ultraorthodox Jewish Women in Regard to Breast Cancer and Screening

Screenings for the early detection of breast cancer greatly improve survival odds. Studies of minority groups have shown lower attendance of screenings; however, these studies seldom focused on religious minorities. This study examines perceptions of cancer and cancer screening among healthy ultraorthodox women in order to gain insight about ways to promote screening. In this qualitative-phenomenological study of two focus groups, three main themes were found: faith in God; the Rabbi as a guide; one’s relationship with the community. The study’s findings point to the importance of studying the unique needs of members of certain religious groups.