Abstract
BackgroundThere is a lack of scientific literature on the application of fear appeals theories to evaluate lung cancer risk perception among smokers. The aim of the present study is to apply the Extended Parallel Process Model (EPPM) to discover the perception of the smokers about their lifetime risk of developing lung cancer (perceived susceptibility), their perception of lung cancer survival (perceived severity), response efficacy, self-efficacy, and readiness to quit.MethodsIn this cross-sectional study, 215 eligible smokers (aged 45 years and over who have smoked at least 1 pack per day in the last 5 years) were recruited. The data collection tool was designed using validate self-report questionnaires and it was contained items on the perceived risk of a smoker contracting lung cancer and perceived lung cancer survival rate. It also had questions to measure the main constructs of the EPPM and Readiness to quit (“Low_Readiness”, and “High_Readiness”). To test how the data support conceptual EPPM to data, Generalized Structural Equation Modeling (GSEM) was used.ResultsFindings showed a significant relationship between Perceived_Susceptibility and Perceived_Response Efficacy; (B = 1.16, P < 0.001); between Perceived_Susceptibility and Perceived_Self Efficacy, (B = -0.93, P < 0.001), Perceived_Severity, and Perceived_Response Efficacy (B = 1.07, P < 0.001). There was also a significant relationship between Perceived_Threat and Perceived_Response Efficacy; between Perceived_Threat and Perceived_Self Efficacy. The relationship between High_Readiness and Perceived_Self Efficacy, and between High_Readiness and Perceived_Severity also were significant. However, the relationships between High_Readiness and Perceived_Threat were not significant (P > 0.05).ConclusionPerceived_threat and Perceived_efficacy were important for smokers with low readiness to quit, while Perceived_efficacy was most important for smokers with high readiness to quit. These findings could be used in promoting lung cancer awareness and designing smoking cessation programs based on smokers’ stages of change.
Highlights
There is a lack of scientific literature on the application of fear appeals theories to evaluate lung cancer risk perception among smokers
Values smaller than 0.08 for Root Mean Square Error of Approximation (RMSEA), the normed chi2 < 5, and values greater than 0.90 for Tucker-Lewis Index (TLI) and Comparative Fit Index (CFI) confirmed the fitness of model [35]
We fit a model with all demographic variables that have a path to “High Readiness”, but since there was no significant relationship between the demographic variable and “High Readiness”, in the step we removed these variables from the model for model parsimony
Summary
There is a lack of scientific literature on the application of fear appeals theories to evaluate lung cancer risk perception among smokers. Effective risk communication depends on presenting general risk factors and preventive information, and on factors that are specific to the individual [10] Behavior models such as the Health Belief Model and Self-Regulation Model, have been used to investigate how smokers perceive the risk of lung cancer [11]. Demographic characteristics of the participants have been measured with the checklist designed from the validated surveys found in the literature, with cultural adaptation These variables include Sex, Ethnicity (Fars, Azeri, Other), Marital status (Engaged, Single, Married, Divorced), Age (years), Education (Middle school, High School, Diploma, Associate degree, Master, Doctorate), Occupation (Farmer, Teacher, Driver, Worker, Office Employee, etc) and Income (IRR4,000,000). 1.Education 2.Occupation 3.Income were used to create a new variable “SES.score” (Score for Socio-Economic Status). A combination of these scores for three variables (Education, Occupation, and Income) was used to create a variable of SES and the “SES.level” was categorized on the scale of 1–3 (Low, Medium, and High)
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