Figure 1 - uploaded by Melody S Goodman
Content may be subject to copyright.
Health Belief Model Components and Linkages The major constructs of the Health Behavior Model are perceived susceptibility, severity, benefits, barriers, and self-efficacy (middle column). Modifying factors (left column) affect these perceptions, as do cues to action (right column). The combination of beliefs and cues to action leads to behavior. Perceived barriers (red text) have been demonstrated to be the single most powerful predictor of health behavior. 11,39,40
Source publication
Background
To investigate perceived barriers to mammography among underserved women, we asked participants in the Siteman Cancer Center Mammography Outreach Registry – developed in 2006 to evaluate mobile mammography’s effectiveness among the underserved – why they believed women did not get mammograms.
Methods
The responses of approximately 9000...
Contexts in source publication
Context 1
... of "receiving bad news", i.e., of abnormalities being found during cancer screening, has been found in some studies to be associated with decreased screening utilization, particularly among black and Hispanic patients, 15-17,20 but fear of finding cancer per se has not been universally found to be a deterrent to cancer-screening participation. 36 Indeed, fear of being diagnosed with cancer has been shown in some studies to be a motivating factor in promoting regular screening utilization. 36,37 Fear of getting cancer -which reflects both perceptions of personal susceptibility and disease severity according to the HBM (Figure 1) -may be an important distinguishing factor between women who do not plan to get a mammogram, women who plan on getting mammograms, and women who actually receive mammograms. 18 Thus, the fact that fear of receiving bad news was one of the three most commonly reported perceived barriers in our cohort may not be a particularly surprising finding given that all of our study participants actually underwent screening mammography. Indeed, it may very well be that for these women, fear proved to be a protective emotion, prompting them to get screened. However, study participants might have reported fear of receiving bad news out of recognition that the same fear that ultimately motivated them to get screened might very well be a deterrent to screening among their friends and family and might even at one time have been a personal deterrent for the registrants ...
Context 2
... Health Belief Model (HBM, Figure 1), first developed by social psychologists in the United States (US) Public Health Service in the 1950s, is a theory of health behavior widely used not only to examine why people do or do not take action to prevent, screen for, or treat disease but also to guide the development of interventions aimed at improving healthcare participation. 10 Over the past 30 years, the HBM has been advanced by Victoria Champion, Celette Skinner, and others as a means through which to improve rates of breast-cancer screening amongst the underserved. 11 Indeed, in large part because of community-based interventions informed by the HBM, racial disparities in mammography utilization in the US have essentially been eliminated. 12 However, as already discussed, geographic pockets of disparity remain both in the state of Missouri and throughout the ...
Context 3
... studies have demonstrated that within the HBM (Figure 1), perceived barriers represent the set of health beliefs most likely to predict health behavior. 11 Thus, in order to efficiently evaluate the efficacy of our mobile mammography program and assess the potential for increased screening participation in the communities served by the mammography van, we asked registrants to share with us their impressions of why women in general might be more or less likely to undergo a screening mammogram: that is, what psychological, logistical, and/or experiential factors did they believe women were likely to perceive as barriers to getting screened? Here, we report the results of our prospective cohort study, which represents the largest review ever conducted of a mobile mammography ...
Citations
... of mammography screening (Kowalski 2021;Løberg et al. 2015). The benefits of mammography screening are further impeded by the lack of organized screening programs, and the fear of mammogram procedural pain (Fayanju et al. 2014;Lim et al. 2022a;Rajendram et al. 2022). ...
A breast cancer risk assessment tool for Asian populations, incorporating Polygenic Risk Score and Gail Model algorithm, has been established and validated. However, effective methods for delivering personalized risk information remain underexplored. This study aims to identify and develop effective methods for conveying breast cancer risk information to Asian women. Through ten focus group discussions with 32 women in Indonesia and Singapore, we explored preferences for the presentation of risk information. Participants favored comprehensive reports featuring actionable steps, simplified language, non-intimidating visuals, and personalized risk reduction recommendations. Singaporean participants, more aware of breast cancer prevention, showed a lower likelihood of seeking follow-ups upon receiving low-risk results compared to Indonesians. Overall, participants found the reports useful and advocated for similar approaches in other disease assessments. Balancing content and complexity in reports is crucial, highlighting the need for improved patient understanding and engagement with healthcare providers. Future studies could explore physicians’ roles in delivering personalized risk assessments for breast cancer prevention.
... 12,59,60 Financially disadvantaged individuals or those in health care resource-limited regions tend to lack screening knowledge and health care provider recommendations, have lower trust in medical care, and face substantial barriers such as transportation and insurance. 61,62 This further results in poorer knowledge of cancer prevention behaviors and compliance with recommended breast cancer screenings. While our study did not identify any significant impact associated with higher poverty rates, county-level unemployment indices, or rurality on breast cancer screening outcomes, it should be noted that neighborhood characteristics may still play a crucial role in influencing cancer occurrence. ...
Background: This study investigated the potential associations between neighborhood characteristics, rurality, ethnicity/race, and breast cancer screening outcomes in designated Health Professional Shortage Areas in Central Texas. Limited access to preventive medical care can impact screening rates and outcomes. Previous research on the effects of factors such as rurality, neighborhood socioeconomic status, and education level on cancer prevention behaviors has yielded inconsistent results.
Materials and Methods: We analyzed data from a state-funded breast and cervical cancer screening programs for disadvantaged and medically underserved individuals. A mixed-effects logistic regression model was used to assess the impact of residency characteristics (rurality, educational attainment, unemployment, and poverty) on abnormal breast cancer screening outcomes, with individual level (age, ethnicity, race, and education) as control variables.
Results: During the studied time, there were 1,139 women screened and 134 abnormal mammograms found. Residency characteristics were not significantly associated with abnormal mammography outcomes at 0.05. However, individual factors are strongly associated with abnormal screening results. Non-Hispanic or Latino white women had increased odds of abnormal clinical outcomes compared with Hispanic or Latino women (OR = 2.03, CI 1.25–3.28; p = 0.004). Additionally, women residing in counties with more than 30% of the population completing college had increased odds of abnormal mammogram outcomes compared with counties with less than 15% college attainment (OR = 2.89, CI 0.99–8.38; p = 0.051).
Conclusions: This study found a significant correlation between area-level educational characteristics and abnormal mammography outcomes. Future research should explore the contextual risk factors influencing breast cancer occurrence and develop targeted interventions for this population.
... Early detection is one of the most effective ways to limit its impact as the earlier it is detected, the sooner treatment can be started. Mammography is the primary method used to detect the presence of cancerous growth but is a painful process that discourages preventive screening (Fayanju et al., 2014). While verbal feedback has provided a good understanding of the discomfort intrinsic to the current procedure, a more objective picture of the process can provide additional insight on the suffering associated with the operation and aid in future improvements to the process, ultimately improving breast cancer screening access and survival rates. ...
... This in conjunction with the pulling of breast tissue during compression along with the simultaneous holding of one's breath results in unpleasant pain and stress for the participants, especially with respect to their muscle tissue. It is generally agreed upon through past research that the procedure is a painful experience, a characteristic that commonly discourages women from participating in the preventive screening process (Fayanju et al., 2014). Most previous work has focused on self-reported pain values and subjective measures of stress and/or discomfort in the muscles being strained, both being metrics which can vary widely and have proven inaccurate in many settings (Kemp et al., 2012). ...
... Through the exclusive use of surveys, many studies indicate women are exposed to pain at some severity because of the compression of breasts, pulling of skin, and/or general positioning (Nielsen et al., 1991;Sapir et al., 2003;Sharp et al., 2003). Additionally, other groups have found that the pain and discomfort associated with the procedure significantly impact re-screening rates/attitudes (Elwood et al., 1998;Fayanju et al., 2014). It is important to note that some studies have not found as significant results as pain scores can also be low amongst sampled populations (Gosein et al., 2014;Moshina et al., 2020). ...
Regular mammograms are recommended for women to allow for early detection of breast cancer and in turn, proper treatment and improved prognosis of patients. However, the stress and discomfort associated with the procedure deter many women from routine screening. Most previous work attempting to characterize this pain utilizes subjective, questionnaire-based methods. The variability in methodology and subjectivity of these approaches requires a more objective strategy to fully understand mammogram related stress. Bio signals such as surface electromyography (sEMG) have been increasing in popularity as a means of quantifying various physiological states including stress and pain. This research presents the use of sEMG as a means of measuring the stress and discomfort experienced by biological females during a mammogram. N=25 healthy subjects were recruited to participate in a simulated procedure consisting of two different variations in machine design (compression paddle shape). Wearable sEMG sensors were placed on 14 different muscles and a multi-metric analysis was conducted to observe muscle activation and estimated stress between a relaxed state and the compressions of the procedure. Significantly activated muscles during the painful mammogram include the deltoid, infraspinatus, teres major, and trapezius upper fibers shown by the most responsive metrics derived. The illustration of intense activation of these muscles during the procedure along with the proposed bio signal analysis methodology can aid in advancing ongoing research and clinical efforts to make mammograms more comfortable and less stressful for patients by providing a more comprehensive understanding of the stress experienced.
... According to studies, only 3% to 17% of Iranian women regularly perform breast self-examination monthly compared to Western women [5,15], also the rate of mammography is identified from 1.6 to 30.5 in Iran [16],while accurate information about the rate of clinical breast examination by midwife or physician has not been reported yet [5]. The studies have reported the following as the barriers to breast cancer screening for all women: lack of knowledge regarding breast cancer screening methods, lack of confidence in their ability to perform breast self-examination correctly, fear of finding a lump in the breast, embarrassment and shame caused by breast manipulation, absence of symptoms and concern due to the lack of awareness, lack of physicians' recommendations, forgetting the breast self-examination schedule, pain caused by breast manipulation during the examination, the deficit in environmental support, cultural beliefs about fate, lack of support from spouse, friends, and families (social support), concerns about the high cost of mammography, pain during mammography, unpleasant test results, and lack of time [17][18][19][20][21][22][23][24]. Furthermore, lack of available information sources and expert personnel as well as the weakness of the referral systems make this problem stable [25]. ...
Introduction
Breast cancer disease is known as the most common cancer among women. Lack of knowledge and awareness is a leading cause of breast cancer, and since nearly all women are increasingly susceptible to this disease, training screening behaviors for early detection is proven essential in order to reduce breast cancer mortality. Therefore, the present study was designed to determine the effect of educational intervention based on the Health Action Model in improving breast cancer screening behaviors in women aged 30 to 69 in Kashan, Iran.
Methods
This quasi-experimental study was conducted on 162 women aged 30–69 years old among the clients of Comprehensive health service centers in Kashan, Iran and they were assigned to intervention and control groups. The research instrument included a questionnaire assessed within three phases: baseline, 3-months, and 6-months, containing Health Action Model (HAM) structures and also three screening behaviors. The intervention consisted of a model-based education package and was carried out over 2 months. To evaluate the effect of the intervention, the mean of model structures and proportion screening behaviors in the third and sixth months were compared with the baseline phase. All analyses were carried out using SPSS, version 22.
Results
The intervention and control groups were homogeneous regarding the structures of the HAM and the proportion of screening behaviors in the baseline phase (p > 0.05). In the 3-month (p < 0.05) and 6-month (p < 0.05) phases, the mean scores of the HAM constructs in the intervention group were found higher compared with the control group. Moreover, the proportion of clinical breast examinations in the intervention group was statistically higher than in the control group in the 3-month (p < 0.001) and 6-month (p < 0.001) phases. In addition, the proportion of mammography performed in the 3-month (p = 0.002) and 6-month (p < 0.001) phases were reported to be higher in the intervention group compared with the control group.
Conclusion
Overall, these results provide important insight into the effectiveness of the interventions based on the Health Action Model in promoting breast cancer screening behaviors and the determinants of such behaviors.
... Additional barriers to screening include lost wages, transportation costs, and continued loss of wages associated with follow up appointments [20]. It was reported that amongst underserved women, the three main barriers to mammogram screening include the fear of the cost of mammography, the fear of pain associated with mammography, and the fear of receiving bad news [21]. ...
... 17,18 Fear of costs of screening has been an obstacle to participation in screening programme among women with low income. 19 Most women who are unemployed do feel unwilling to ask for financial assistance from their husband and kids to go for screening. 20,21,22 Language barrier is also one of the factors that determine the participation of individuals in screening programme. ...
... 24 Documented barriers to mammography screening among Black women encompass individual, structural, and systems-level barriers and contribute to a higher mortality rate among this population. 1,23,[25][26][27][28][29] Increasing mammography screening rates among Black women in underserved communities is responsive to the HP 2030 goals. ...
Background:
In the United States (US), Black/African American women suffer disproportionately from breast cancer health disparities with a 40% higher death rate compared to White women. Mammography screening is considered a critical tool in mitigating disparities, yet Black women experience barriers to screening and are more likely to be diagnosed with advanced-stage breast cancer. The purpose of this study was to assess the relative frequency of mammography screening and to examine perceived and actual barriers to screening among women who receive care in our nurse-led community health center.
Methods:
We conducted a survey examining frequency of mammography screening and beliefs about breast cancer including perceived susceptibility, perceived benefits, and perceived barriers to mammography screening, guided by the Champion Health Belief Model.
Results:
A total of 30 Black/African American women completed the survey. The mean age of the participants was 54.3 years ± 9.17 (SD); 43.3% had a high school education or less; 50% had incomes below $60,000 per year; 26.7% were uninsured; 10% were on Medicaid; and only 50% were working full-time. We found that only half of the participants reported having annual mammograms 16 (53.3%), 1 (3.3%) every 6 months, 8 (26.6%) every 2-3 years, and 5 (16.7%) never had a mammogram in their lifetime. Frequently cited barriers included: 'getting a mammogram would be inconvenient for me'; 'getting a mammogram could cause breast cancer'; 'the treatment I would get for breast cancer would be worse than the cancer itself'; 'being treated for breast cancer would cause me a lot of problems'; 'other health problems would keep me from having a mammogram'; concern about pain with having a mammogram would keep me from having one; and not being able to afford a mammogram would keep me from having one'. Having no health insurance was also a barrier.
Conclusion:
This study found suboptimal utilization of annual screening mammograms among low-income Black women at a community health center in Florida and women reported several barriers. Given the high mortality rate of breast cancer among Black/African American women, we have integrated a Patient Navigator in our health system to reduce barriers to breast cancer screening, follow-up care, and to facilitate timely access to treatment, thus ultimately reducing breast cancer health disparities and promoting health equity.
... While previous studies have shown that same-day screening and biopsy workflow models can be effective strategies to mitigate disparities in breast imaging, further research is needed to examine whether such changes will produce the intended results. There are many factors that contribute to healthcare disparities in mammography, such as inadequate insurance coverage, limited appointment times during business hours, time and transportation needs to travel to and from diagnostic facilities, availability of childcare coverage, fear of pain, fear of receiving bad news, and mistrust of the health system (4,5,23,32,33). Additional studies should examine whether such changes in imaging workflow can further reduce psychosocial consequences related to anxiety, fear, and distress, and whether such reductions are similar between Black women and NHW women. ...
Objective
To examine time from screening to diagnostic workup, biopsy, and surgery for non-Hispanic White (NHW) and Black women following implementation of a same-day biopsy program.
Methods
All NHW and Black women with BI-RADS category 0 screening mammogram at Duke University Hospital were identified between August 1, 2020, and August 1, 2021. Patient characteristics were recorded. Time between screening mammogram, diagnostic workup, breast biopsy, surgical consultation, and surgery were recorded. Comparisons were made between NHW and Black women using a multivariable regression model. Diagnostic imaging to biopsy time interval was compared to historical averages before same-day biopsy implementation.
Results
There were 2156 women: 69.9% NHW (1508/2156) and 30.1% Black (648/2156). Mean ± standard deviation time from screening to diagnostic imaging overall was 13.5 ± 32.5 days but longer for Black (18.0 ± 48.3 days) than for NHW women (11.5 ± 22.2 days) (P < 0.001). The mean time from diagnostic mammogram to biopsy was 5.9 ± 18.9 days, longer for Black (9.0 ± 27.9 days) than for NHW women (4.4 ± 11.8 days) (P = 0.017). The same-day biopsy program shortened the time from diagnostic imaging to biopsy overall (12.5 ± 12.4 days vs 5.9 ± 18.9 days; P < 0.001), with a significant reduction for NHW women (12.4 ± 11.7 days vs 4.4 ± 11.8 days) (P < 0.001) but not Black women (11.5 ± 9.9 days vs 9.0 ± 27.9 days) (P = 0.527).
Conclusion
Disparities exist along the breast imaging pathway. A same-day biopsy program benefited NHW women more than Black women.
... Комбинацијата на верувања и знаци за акција доведува до однесување. Согледаните бариери (црвениот текст) се покажаа како единствениот најмоќен предиктор за здравственото однесување (Fayanju et al., 2014). ...
The research study, that is, the monograph dedicated to visual health communication during a global health crisis defines the concepts of health communication and health literacy, and the theories of health communication are also explained. It also elaborates the concept of visual communications in health systems/communications, and the main focus is on the poster as a channel of mass communication and its constitutive elements. The theoretical components of the pragmatic researches of language and communications are also covered.
Regarding the methodological part, it includes a systematic literature review as well as quantitative and qualitative content analysis of a sample of 113 digital posters. Then follows the psychological elaboration of the problem, as well as practical guidelines for communication strategies and campaigns regarding health crisis and digital poster preparation within the framework of visual health communication.
... The studies have reported the following as the barriers to breast cancer screening for all women: The lack of knowledge about breast cancer screening methods, lack of con dence in their ability to perform breast self-examination correctly, fear of nding a lump in the breast, embarrassment and shame caused by breast manipulation, absence of symptoms and concern due to the lack of awareness, lack of physicians' recommendations, forgetting the breast self-examination schedule, pain caused by breast manipulation during the examination, the de cit in environmental support, cultural beliefs about fate, lack of support from spouse, friends, and families (social support), concerns about the high cost of mammography, pain during mammography, unpleasant test results, and lack of time [20][21][22][23][24][25][26][27]. Furthermore, the lack of available information sources and expert personnel as well as the weakness of the referral systems, make this problem stable [28]. ...
Introduction: Breast cancer is the most common cancer in women. Considering the lack of knowledge about the cause of breast cancer and since all women are susceptible to this disease, training screening behaviors for early diagnosis is essential to reduce the mortality from this disease. Therefore, the present study aimed to determine the effect of training based on the health action model in improving breast cancer screening behaviors in women aged 30 to 69 in Kashan City.
Methods: The present study was semi-experimental and the research setting included comprehensive health service centers in Kashan. The statistical population was women aged 30 to 69. A total of 162 women in the same age group were selected to participate in the study by simple random sampling. They were divided into two intervention and control groups. Before the educational intervention, a questionnaire distributed between two groups. The educational package was designed and prepared after analyzing the initial data of the questionnaires. The educational intervention was performed in both virtual (Whatsapp platform) and attendance methods for the intervention group over two months. All participants completed informed consent forms before the study. The questionnaires were distributed and collected in three periods before, three, and six months after the educational intervention. The data was analyzed using SPSS 22 software.
Findings: The mean scores of knowledge, perceived susceptibility, severity, barriers, benefits, self-efficacy, subjective norms, skills and behavioral intention related to monthly breast self-examination, clinical examination and mammography, significantly increased in the intervention group compared to the control group three and six months after the intervention. Furthermore, screening behaviors, including monthly breast self-examination, clinical examination and mammography, significantly increased in the intervention group compared to the control group 3 three and six months after the intervention (P<0.05).
Conclusion: The research results proved the effectiveness of interventions based on the health action model in promoting breast cancer screening behaviors and the determinants of such behaviors.