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Evaluating the Health Belief Model: A critical review of studies predicting mammographic and pap screening

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Abstract

Conclusions from empirical research employing the Health Belief Model (HBM) to investigate breast and cervical cancer and women's preventive health behaviors have been inconsistent and sometimes addressed contradictory, leading scholars to question utility of the model. Therefore we address utility of the HBM by conducting a comprehensive literature review. Using 10 electronic databases, we identified 39 published studies applying the HBM to mammographic and/or Papanicolaou (pap) screening. Overall, we found strongest support for the HBM's perceived benefit and barrier constructs, compared to other constructs. Weakest support was found for the HBM's perceptions of the disease construct. More recently collected data from nationally representative and ethnically/racially diverse samples, as well as more sophisticated methodological approaches are necessary to further evaluate the HBM.

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References

  • Aiken, L.S., West, S.G., Woodward, C.K. and Reno, R.R. (1994) Health beliefs and compliance with mammography-screening recommendations in asymptomatic women. Health Psychology 13: 122–129.

    Article  Google Scholar 

  • Aiken, L.S., Fenaughty, A.M., West, S.G., Johnson, J.J. and Luckett, T.L. (1995) Perceived determinants of risk for breast cancer and the relations among objective risk, perceived risk, and screening behavior over time. Women's Health: Research on Gender, Behavior, and Policy 1: 27–50.

    Google Scholar 

  • Allison, P.D. (1999) Multiple Regression: A Primer. Thousand Oaks, CA: Pine Forge Press.

    Google Scholar 

  • American Cancer Society. (2009) Estimated New Cancer Cases and Deaths by Sex, US, 2009. Atlanta, GA: American Cancer Society.

  • Asher, H.B. (1976) Causal Modeling. Beverly Hills, CA: Sage Publications.

    Google Scholar 

  • Ashing-Giwa, K. (1999) Health behavior change models and their socio-cultural relevance for breast cancer screening in African American women. Women & Health 28: 53–71.

    Article  Google Scholar 

  • Austin, L.T., Ahmad, F., McNally, M.J. and Stewart, D.E. (2002) Breast and cervical cancer screening in Hispanic women: A literature review using the Health Belief Model. Women's Health Issues 12: 122–128.

    Article  Google Scholar 

  • Becker, M.H (ed.) (1974a) The Health Belief Model and Personal Health Behavior. Thorofare, NJ: Charles B. Slack Inc.

    Google Scholar 

  • Becker, M.H. (1974b) The Health Belief Model and personal health behavior. Health Education Monographs 2: 324–473.

    Article  Google Scholar 

  • Bloom, J.R., Grazier, K., Hodge, F. and Hayes, W.A. (1991) Factors affecting the use of screening mammography among African American women. Cancer Epidemiology, Biomarkers & Prevention 1: 75–82.

    Google Scholar 

  • Buki, L.P., Borrayo, E.A., Feigal, B.M. and Carrillo, I.Y. (2004) Are all Latinas the same? Perceived breast cancer screening barriers and facilitative conditions. Psychology of Women Quarterly 28: 400–411.

    Article  Google Scholar 

  • Burack, R.C. and Liang, J. (1989) The acceptance and completion of mammography by older Black women. American Journal of Public Health 79: 721–726.

    Article  Google Scholar 

  • Champion, V. (1991) The relationship of selected variables to breast cancer detection behaviors in women 35 and older. Oncology Nursing Forum 18: 733–739.

    Google Scholar 

  • Champion, V. (1992) Compliance with guidelines for mammography screening. Cancer Detection and Prevention 16: 253–258.

    Google Scholar 

  • Champion, V. (1995) Development of a benefits and barriers scale for mammography utilization. Cancer Nursing 18: 53–59.

    Article  Google Scholar 

  • Champion, V. (1999) Revised susceptibility, benefits, and barriers scale for mammography screening. Research in Nursing & Health 22: 341–348.

    Article  Google Scholar 

  • Champion, V. and Menon, U. (1997) Predicting mammography and breast self-examination in African American women. Cancer Nursing 20: 315–322.

    Article  Google Scholar 

  • Champion, V. and Scott, C.R. (1997) Reliability and validity of breast cancer screening belief scales in African American women. Nursing Research 46: 331–337.

    Article  Google Scholar 

  • Champion, V.L. et al (2008) Measuring mammography and breast cancer beliefs in African American women. Journal of Health Psychology 13: 827–837.

    Article  Google Scholar 

  • Cockburn, J., Murphy, B., Schofield, P., Hill, D. and Borland, R. (1991) Development of a strategy to encourage attendance for screening mammography. Health Education Research 6: 279–290.

    Article  Google Scholar 

  • Curry, S.J. and Emmons, K.M. (1994) Theoretical models for predicting and improving compliance with breast cancer screening. Annals of Behavioral Medicine 16: 302–316.

    Google Scholar 

  • Duke, S.S., Gordon-Sosby, K., Reynolds, K.D. and Gram, I.T. (1994) A study of breast cancer detection practices and beliefs in Black women attending public health clinics. Health Education Research 9: 331–342.

    Article  Google Scholar 

  • Fulton, J.P., Rakowski, W. and Jones, A.C. (1995) Determinants of breast cancer screening among inner-city Hispanic women in comparison with other inner-city women. Public Health Reports 110: 476–482.

    Google Scholar 

  • Fulton, J.P. et al (1991) A study guided by the Health Belief Model of the predictors of breast cancer screening of women ages 40 and older. Public Health Reports 106: 410–420.

    Google Scholar 

  • Gillam, S.J. (1991) Understanding the uptake of cervical cancer screening: The contribution of the Health Belief Model. British Journal of General Practice 41: 510–513.

    Google Scholar 

  • Hennig, P. and Knowles, A. (1990) Factors influencing women over 40 years to take precautions against cervical cancer. Journal of Applied Social Psychology 20: 1612–1621.

    Article  Google Scholar 

  • Hochbaum, G.M. (1958) Public participation in medical screening programs: A socio-psychological study. PHS publication 572. Washington DC: Government Printing Office.

    Google Scholar 

  • Holm, C.J., Frank, D.I. and Curtin, J. (1999) Health beliefs, health locus of control, and women's mammography behavior. Cancer Nursing 22: 149–156.

    Article  Google Scholar 

  • Hyman, R.B., Baker, S., Ephraim, R., Moadel, A. and Philip, J. (1994) Health Belief Model variables as predictors of screening mammography utilization. Journal of Behavioral Medicine 17: 391–406.

    Article  Google Scholar 

  • Ingledue, K., Cottrell, R. and Bernard, A. (2004) College women's knowledge, perceptions, and preventive behaviors regarding human papillomavirus infection and cervical cancer. American Journal of Health Studies 19: 28–34.

    Google Scholar 

  • Janz, N.K., Champion, V.L. and Strecher, V.J. (2002) The Health Belief Model. In: K. Glanz, B. K. Rimer and F. M. Lewis (eds.) Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass, pp. 45–66.

    Google Scholar 

  • Jepson, C., Kessler, L.G., Portnoy, B. and Gibbs, T. (1991) Black-White differences in cancer prevention knowledge and behavior. American Journal of Public Health 81: 501–504.

    Article  Google Scholar 

  • Kash, K.M., Holland, J.C., Halper, M.S. and Miller, D.G. (1992) Psychological distress and surveillance behaviors of women with a family history of breast cancer. Journal of the National Cancer Institute 84: 24–30.

    Article  Google Scholar 

  • Ko, C.M., Sadler, G.R., Ryujin, L. and Dong, A. (2003) Filipina American women's breast cancer knowledge, attitudes, and screening behaviors. BMC Public Health 3: 27.

    Article  Google Scholar 

  • Kurtz, M.E., Given, B., Given, C.W. and Kurtz, J.C. (1993) Relationships of barriers and facilitators to breast self-examination, mammography, and clinical breast examination in a worksite population. Cancer Nursing 16: 251–259.

    Google Scholar 

  • Lerman, C., Caputo, C. and Brody, D. (1990) Factors associated with inadequate cervical cancer screening among lower income primary care patients. The Journal of the American Board of Family Practice 3: 151–156.

    Google Scholar 

  • Long, J.S. (1983) Covariance Structure Models. Beverly Hills, CA: Sage.

    Book  Google Scholar 

  • Mandelblatt, J., Traxler, M., Lakin, P., Kanetsky, P., Kao, R. and the Harlem Study Team (1992) Mammography and Papanicolaou smear use by elderly poor Black women. Journal of the American Geriatrics Society 40: 1001–1007.

    Article  Google Scholar 

  • Mandelblatt, J., Traxler, M., Lakin, P., Kanetsky, P., Kao, R. and the Harlem Study Team (1993) Targeting breast and cervical cancer screening to elderly poor black women: Who will participate? Preventive Medicine 22: 20–33.

    Article  Google Scholar 

  • McFarland, D.M. (2003) Cervical cancer and pap smear screening in Botswana: Knowledge and perceptions. International Nursing Review 50: 167–175.

    Article  Google Scholar 

  • Mikhail, B. (1981) The Health Belief Model: A review and critical evaluation of the model, research, and practice. Advances in Nursing Science 4: 65–82.

    Article  Google Scholar 

  • National Center for Health Statistics. (2009) Health, United States, 2008. Hyattsville, MD: U.S. Government Printing Office.

  • Orbell, S. (1996) Cognition and affect after cervical screening: The role of previous test outcome and personal obligation in future uptake expectations. Social Science & Medicine 43: 1237–1243.

    Article  Google Scholar 

  • Pearlman, D.N., Clark, M.A., Rakowski, W. and Ehrich, B. (1999) Screening for breast and cervical cancers: The importance of knowledge and perceived cancer survivability. Women & Health 28: 93–112.

    Article  Google Scholar 

  • Phillips, J.M. and Wilbur, J. (1995) Adherence to breast cancer screening guidelines among African-American women of differing employment status. Cancer Nursing 18: 258–269.

    Article  Google Scholar 

  • Price, J.H., Desmond, S.M., Slenker, S., Smith, D. and Stewart, P.W. (1992) Urban Black women's perceptions of breast cancer and mammography. Journal of Community Health 17: 191–204.

    Article  Google Scholar 

  • Rimer, B.K. (1995) Audiences and messages for breast and cervical cancer screenings. Wellness Perspectives: Research, Theory, and Practice 11: 13–39.

    Google Scholar 

  • Rimer, B.K., Trock, B., Engstrom, P.F., Lerman, C. and King, E. (1991) Why do some women get regular mammograms? American Journal of Preventive Medicine 7: 69–74.

    Google Scholar 

  • Rosenstock, I.M. (1960) What research in motivation suggests for public health. American Journal of Public Health 50: 295–302.

    Article  Google Scholar 

  • Rosenstock, I.M. (1974) Historical origins of the Health Belief Model. In M. H. Becker (ed.) The Health Belief Model and Personal Health Behavior. Thorofare, NJ: Charles B. Slack, pp. 1–8.

    Google Scholar 

  • Rutledge, D.N., Hartmann, W.H., Kinman, P.O. and Winfield, A.C. (1988) Exploration of factors affecting mammography behaviors. Preventive Medicine 17: 412–422.

    Article  Google Scholar 

  • Sadler, G.R., Ryujin, L.T., Ko, C.M. and Nguyen, E. (2001) Korean women: Breast cancer knowledge, attitudes, and behaviors. BMC Public Health 1: 7.

    Article  Google Scholar 

  • Savage, S.A. and Clarke, V.A. (2001) Factors associated with breast and cervical cancer screening behaviours. Health Education 101: 176–186.

    Article  Google Scholar 

  • Schulmeister, L. and Lifsey, D.S. (1999) Cervical cancer screening knowledge, behaviors, and beliefs of Vietnamese women. Oncology Nursing Forum 26: 879–887.

    Google Scholar 

  • Seow, A., Wong, M.L., Smith, W.C.S. and Lee, H.P. (1995) Beliefs and attitudes as determinants of cervical cancer screening: A community-based study in Singapore. Preventive Medicine 24: 134–141.

    Article  Google Scholar 

  • Stein, J.A., Fox, S.A., Murata, P.J. and Morisky, D.E. (1992) Mammography usage and the Health Belief Model. Health Education & Behavior 19: 447–462.

    Article  Google Scholar 

  • Taplin, S., Anderman, C. and Grothaus, L. (1989) Breast cancer risk and participation in mammographic screening. American Journal of Public Health 79: 1494–1498.

    Article  Google Scholar 

  • Thomas, L.R., Fox, S.A., Leake, B.G. and Roetzheim, R.G. (1996) The effects of health beliefs on screening mammography utilization among a diverse sample of older women. Women & Health 24: 77–94.

    Article  Google Scholar 

  • Vadaparampil, S.T., Champion, V.L., Miller, T.K., Menon, U. and Skinner, C.S. (2003) Using the Health Belief Model to examine differences in adherence to mammography among African-American and Caucasian women. Journal of Psychosocial Oncology 21: 59–79.

    Article  Google Scholar 

  • Vernon, S.W. (1999) Risk perception and risk communication for cancer screening behaviors: A review. Journal of the National Cancer Institute Monographs 25: 101–119.

    Article  Google Scholar 

  • Watson, E.K., Henderson, B.J., Brett, J., Bankhead, C. and Austoker, J. (2005) The psychological impact of mammographic screening on women with a family history of breast cancer – A systematic review. Psycho-Oncology 14: 939–948.

    Article  Google Scholar 

  • Weissfeld, J.L., Brock, B.M., Kirscht, J.P. and Hawthorne, V.M. (1987) Reliability of health belief indexes: Confirmatory factor analysis in sex, race, and age subgroups. Health Services Research 21: 777–793.

    Google Scholar 

  • Yarbrough, S.S. and Braden, C.J. (2001) Utility of Health Belief Model as a guide for explaining or predicting breast cancer screening behaviours. Journal of Advanced Nursing 33: 677–688.

    Article  Google Scholar 

  • Yi, J.K. and Prows, S.L. (1996) Breast cancer screening practices among Cambodian women in Houston, Texas. Journal of Cancer Education 11: 221–225.

    Google Scholar 

  • Zapka, J.G., Stoddard, A.M., Costanza, M.E. and Greene, H.L. (1989) Breast cancer screening by mammography: Utilization and associated factors. American Journal of Public Health 79: 1499–1502.

    Article  Google Scholar 

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Tanner-Smith, E., Brown, T. Evaluating the Health Belief Model: A critical review of studies predicting mammographic and pap screening. Soc Theory Health 8, 95–125 (2010). https://doi.org/10.1057/sth.2009.23

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