Determinants of Intention to Participate in Breast Cancer Screening among Urban Chinese Women: An Application of the Protection Motivation Theory

Abstract

Despite the significance of early detection of breast cancer through screening, the screening uptake in China remains relatively low. Protection motivation theory (PMT) suggested by Rogers is one of the theories concerning threat appeal. This study aimed to apply the protection motivation theory (PMT) in predicting breast cancer screening intention. In this cross-sectional study, a sample of Chinese urban women was recruited using the convenient sampling method from five communities in Wuhan. Data were collected using a self-report questionnaire that included demographic variables, knowledge about breast cancer, six PMT subconstructs, and screening intention. We used the structural equation modeling (SEM) to identify the predictor factors associated with screening intention. Of the total sample (n = 412), 86.65% had intention to participate in screening. Our data fit the hypothesized SEM model well (Goodness of fit index (GFI) = 0.91, adjusted GFI (AGFI) = 0.89, comparative fit index (CFI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, standardized root mean residual (SRMR) = 0.06, and Chi-square/df = 2.01). Three PMT subconstructs (perceived severity, response cost, and self-efficacy) were significantly associated with screening intention. Knowledge, social status, and medical history had significantly indirect associations with screening intention through the mediating effect of PMT subconstructs. Considering the utility of PMT, intervention programs might be more effective based on the subconstructs of PMT, especially to improve self-efficacy, perceived severity, and knowledge, reduce response cost, as well as targeting specific demographic groups.

Validating Rural Women's Intentions and Behaviors to Participate in Two- Cancer Screening Using Extended Protection Motivation Theory in an Area of Mongolian Agglomeration

“…As opposed to other studies with a sole outcome variable, this study subdivided the outcome variable into behavioral intentions and behaviors. The results of this study also extend previous studies on cervical cancer screening and breast cancer screening conducted in China (Bai Y et al, 2018c;Zhang M et al, 2021b). This study showed that health education had a direct and most signi cant effect on cognitive severity and self-e cacy, screening knowledge on self-e cacy, technical service support, environmental improvement, and self-e cacy on behavioral intentions, and social support and fear arousal on behaviors.…”

“…The protective motivation theory suggests that an individual's ultimate health behaviors are determined by a combination of external objective environmental factors and internal subjective personal factors. Many studies have used the protective motivation theory to explain the motivation of health behaviors in populations, mainly in screening behaviors for colorectal, skin, cervical, and breast cancers (Bai Y et al, 2018;Roozbahani N et al, 2020;Wei W et al, 2022;Zhang M et al, 2021b). Previous studies have shown that rural residents have signi cantly lower uptake of cancer screening for colorectal, cervical, and breast cancers relative to urban residents, which may lead to poorer survival (Walji LT et al, 2021).…”

Investigating the Effect of Tailored Educational Program Based on Protection Motivation Theory on Mammography Adherence in Iranian Women

“…Breast self-awareness and preventive self-regulation behaviors such as lifestyle, nutrition, and physical activity were introduced to the participants, and they understood and internalized the benefits of these solutions which led to the promotion of their self-efficacy. Zhang et al aimed to determine the determinants of the intention of breast cancer screening behaviors in Chinese women based on the PMT, and their findings showed that self-efficacy is directly related to the intention of mammography behavior (42). Rezaeian et al conducted a study to determine the effect of an educational program based on the Health Belief Model on the knowledge and health beliefs of 290 women aged 40 and over about breast cancer and mammography in Isfahan and reported a statistically significant difference (P > 0.05) in the mean scores of the constructs of perceived sensitivity, perceived severity, perceived benefits and barriers, self-efficacy, and motivation of women in the test group compared to women in the control group after the educational intervention (43).…”

Predictors of breast self‐examination behavior among adult females in Najran city, Saudi Arabia

“…They also recommended that healthcare providers develop educational programs based on PMT to enhance BC screening behaviors. Zhang et al (2021) examined BC screening intention based on PMT among Chinese adult females. They confirmed the significant role of PMT in BC screening by using structural equation modeling.…”