Factors Affecting Breast Cancer Screening Behavior in Japan - Assessment using the Health Belief Model and Conjoint Analysis

Abstract

Background: Japanese women in their 40s or older have been encouraged to attend breast cancer screening. However, the breast cancer screening rate in Japan is not as high as in Europe and the United States. The aim of this study was to identify psychological and personal characteristics of women concerning their participation in breast cancer screening using the Health Belief Model (HBM). In addition, the attributes of screening more easily accepted by participants were analyzed by conjoint analysis. Materials and Methods: In this cross sectional study of 3,200 age 20-69 women, data were collected by an anonymous questionnaire. Questions were based on HBM and personal characteristics, and included attitudes on hypothetical screening attributes. Data of women aged 40-69 were analyzed by logistic regression and conjoint analysis to clarify the factors affecting their participation in breast cancer screening. Results: Among responses collected from 1,280 women of age 20-69, the replies of 993 women of age 40-69 were used in the analysis. Regarding the psychological characteristics based on HBM, the odds ratios were significantly higher in "importance of cancer screening" (95%CI: 1.21-2.47) and "benefits of cancer screening" (95%CI: 1.09-2.49), whereas the odds ratio was significantly lower in "barriers to participation before cancer screening" (95%CI: 0.27-0.51). Conjoint analysis revealed that the respondents, overall, preferred screening to be low cost and by female staff members. Furthermore, it was also clarified that attributes of screening dominant in decision-making were influenced by the employment status and the type of medical insurance of the women. Conclusions: In order to increase participation in breast cancer screening, it is necessary to disseminate accurate knowledge on cancer screening and to reduce barriers to participation. In addition, the attributes of screening more easily accepted were inexpensive, provided by female staff, executed in a hospital and finished in a short time.

Attitudes of South Asian Women to Breast Health and Breast Cancer Screening: Findings from a Community Based Sample in the United States

“…Its validity and reliability has been replicated among several racial and Asian ethnic minority populations across the world (Champion et al, 2008;Parsa et al, 2008;Anagnostopoulos et al, 2012;Tsangari and Petro-Nustas, 2012;Fouladi et al, 2013;Subramanian et al, 2013;Tsunematsu et al, 2013). While much of the prior work done to examine attitudes and beliefs towards cancer and screening among South Asians has been limited to small qualitative studies (Kishore et al, 2008;Karbani et al, 2011), this is the first community sample from two large metropolitan cities in the US that used constructs from the HBM to examine breast cancer screening attitudes.…”

“…Our study showed a disturbing pattern of reduced perception among South Asians to their susceptibility to breast cancer in spite of increased risks associated with changing lifestyles and environmental exposures. Studies from other Asian populations (e.g., Japanese) that have much higher screening rates (64%) show that awareness of cancer screening benefits along with lower barriers to obtaining screening are crucial to motivating participation in breast cancer screening (Tsunematsu et al, 2013). A systematic review of the literature shows that interventions on breast cancer screening that were adapted from the HBM, obtained positive changes in screening behavior when nurses employed components of the HBM to promote awareness of early screening (Ersin and Bahar, 2011).…”

“…Across the various studies among South Asians, the mammography rates range from 30-56%. This is notably low, compared to other Asian sub-groups (e.g., the Japanese) or non-Hispanic whites whose rates are as high as 65-70% (Lee et al, 2010;Tsunematsu et al, 2013). In developing countries, minimal public awareness about breast cancer may be responsible for poor cancer screening behaviors (Khokhar, 2012a); however, studies in the Western world report access and acculturation-related factors to be associated with lower use of breast cancer screening in South Asian women (Islam et al, 2006;Glenn et al, 2009;Rakowski et al, 2010;Menon et al, 2012).…”

What is the Most Effective Strategy for Improving the Cancer Screening Rate in Japan?

“…The MHLW reported that implementing cancer screening and specific health checkups simultaneously improved cancer screening rates in some municipalities (MHLW, 2012b). In addition to these strategies, future studies that determine other effective strategies for improving cancer screening rates are warranted, including where screening occurs and the medical personnel involved (Tsunematsu et al, 2013).…”

Turkish Social Attitudes towards to Cancer Prevention: a Health Belief Model Study

“…The understanding of the reason behind people's not having a positive attitude towards cancer prevention and early diagnosis is important in cancer prevention research. There are many scientific researches to prevent breast cancer, cervical cancer and colorectal cancer by using health belief model (Gozum et al, 2004;Gercek et al, 2008;Kilic et al, 2009;Gozum et al, 2010;Aydogdu and Bahar, 2011;Ersin and Bahar, 2011;Tasci-Duran, 2011;Fouladi et al, 2013;Tsunematsu et al, 2013;Kharameh et al, 2014). Nevertheless, in general, there are no research related to cancer prevention and early diagnosis using health belief model.…”