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

Abstract

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.

The Demographic, System, and Psychosocial Origins of Mammographic Screening Disparities: Prediction of Initiation Versus Maintenance Screening Among Immigrant and Non-Immigrant Women

“…More broadly, because attitudinal, cognitive, and emotional factors are recursively related to screening, with psychological characteristics predicting screening but also changing in response to screening experiences, the links such factors have with behavior may vary depending on whether we are examining the initiation versus the maintenance of a screening profile. Consistent with this suggestion, prior experiences are only weakly predictive of future screening [52,53] and the negative psychological impact of second stage screening may not persist beyond the receipt of a negative result [54].…”

Mammography Screening within the Context of the Theory of Planned Behavior: The Role of Personality Traits and Personal Factors

“…In the study by Tolma et al (2006), age and educational level and health-related factors such as practicing clinical breast examination and breast self-examination, significantly contributed to the prediction of intention after controlling for the TPB components. Similar effects were reported in the study by Drossaert, Boer, and Seydel (2003) for age, educational level and marital status on predicting mammography screening attendance. Findings of the present study suggested that for older women and for women who had been diagnosed with benign lesions in the past, attitudes, normative pressure, or perceptions of behavioral control might not play a pivotal role in their decision about undertaking mammography screening.…”

“…The direct association found between intention and mammography screening confirmed that intention was the most significant proximal determinant of behavior, as suggested by the TPB. Although intention does not necessarily mean that action will follow, referred in literature as the "intention-behavior gap", prospective studies on breast cancer screening indicate successful prediction of mammography utilization within up to six years (Drossaert, Boer, & Seydel, 2003;Rutter, 2000). Furthermore, the association between attitudes and intention and between perceived behavioral control and intention was in line with the tenets of the TPB.…”

“…In addition to these factors, some studies have explored the effect of sociodemographic characteristics and health-related variables, such as family history of breast cancer, or a previous benign diagnosis, on both intention and mammography screening after controlling for TPB variables. Findings reveal direct associations between screening and some of these variables including age, education, and practice of breast-self examination or clinical breast examination (Bowie et al, 2003;Drossaert, Boer, & Seydel, 2003;Tolma et al, 2006).…”

Factors Affecting Cancer Screening Intention and Behavior of the Korean Elderly

“…Furthermore, a lower perceived barrier was associated with increased cancer screening behavior. Previous studies have also shown that perceived behavioral control was an influential factor for cancer screening behavior (Drossaert et al, 2003;Honda et al, 2006;Orbell et al, 2006). The group with lower perceived behavioral control showed improved cancer screening behavior, indicating that removing the obstacles to cancer screenings can increase the rates of cancer screening.…”