Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: A cross-sectional survey

Danika Marmarà (Lead / Corresponding author), Vincent Marmarà, Gill Hubbard

Research output: Contribution to journalArticlepeer-review

39 Citations (Scopus)
40 Downloads (Pure)

Abstract

Background: Women's beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. This study utilized the health belief model (HBM) and common-sense model (CSM) of illness self-regulation to explore factors associated with BS uptake in Malta and subsequently, to identify the most important predictors to first screening uptake. 

Methods: This cross-sectional survey enrolled Maltese women (n = 404) ages 50 to 60 at the time of their first screening invitation, invited to the National Breast Screening Programme by stratified random sampling, with no personal history of BC. Participants responded to a 121-item questionnaire by telephone between June-September 2015. Data were analyzed using descriptive statistics, chi-square tests and logistic regression. 

Results: There is high awareness of BC signs and symptoms among Maltese women (>80% agreement for 7 out of 8 signs), but wide variation about causation (e.g., germ or virus: 38.6% 'agree', 30.7% 'disagree'). 'Fear' was the key reason for non-attendance to first invitation (41%, n = 66) and was statistically significant across all subscale items (p < 0.05). Most items within HBM constructs (perceived barriers; cues to action; self-efficacy) were significantly associated with first invitation to the National Breast Screening Programme, such as fear of result (χ2 = 12.0, p = 0.017) and life problems were considered greater than getting mammography (χ2 = 38.8, p = 0.000). Items within CSM constructs of Illness Representation (BC causes; cyclical cancer timeline; consequences) were also significantly associated, such as BC was considered to be life-changing (χ2 = 18.0, p = 0.000) with serious financial consequences (χ2 = 13.3, p = 0.004). There were no significant associations for socio-demographic or health status variables with uptake, except for family income (χ2 = 9.7, p = 0.047). Logistic regression analyses showed that HBM constructs, in particular perceived barriers, were the strongest predictors of non-attendance to first invitation throughout the analyses (p < 0.05). However, the inclusion of illness representation dimensions improved the model accuracy to predict non-attendance when compared to HBM alone (65% vs 38.8%). 

Conclusions: Interventions should be based on theory including HBM and CSM constructs, and should target first BS uptake and specific barriers to reduce disparities and increase BS uptake in Malta.

Original languageEnglish
Article number416
Number of pages19
JournalBMC Public Health
Volume17
Issue number1
DOIs
Publication statusPublished - 8 May 2017

Keywords

  • Breast cancer screening
  • Common-sense model
  • Factors
  • Health belief model
  • Mammography
  • Uptake

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Fingerprint

Dive into the research topics of 'Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: A cross-sectional survey'. Together they form a unique fingerprint.

Cite this