Abstract
BackgroundWomen’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.MethodsThis 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.ResultsThere 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%).ConclusionsInterventions 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.
Highlights
Women’s beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices
Nearly 70% of women in this study reported that they were not encouraged by their General practitioner (GP) to attend to breast screening
We found only one Greek study which incorporated both health belief model (HBM) and common-sense model (CSM) to explore health beliefs and illness perceptions [17], though this theoretical framework was related to lifetime mammography use as opposed to our study regarding BS uptake in an organised programme
Summary
Women’s beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. BC accounts for 21% of all female cancer incidences in Malta with an average of 280 women diagnosed each year, over the last decade [4]. Detection of BC reduces morbidity and mortality, resulting in more effective treatment regimens and better survival rates [5]. Such mortality reductions are largely dependent on interventions, such as breast selfexamination, clinical breast examination and screening [6]. European Guidelines for Quality Assurance in BC [12] promote an acceptable target screening rate of at least 70%, and ideally 75% of eligible women [13], less than 60% of Maltese women accepted their first screening invitation [14] from a national breast screening programme, introduced in 2009 for women aged 50–60 years [13]. Since its establishment in Malta, the Maltese Breast Screening Programme (MBSP) routinely invites women free-ofcharge by letter every three years and has expanded its cohort in its second screening round to include women aged 61–66 years
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