Fear, Knowledge, and Efficacy Beliefs Differentially Predict the Frequency of Digital Rectal Examination Versus Prostate Specific Antigen Screening in Ethnically Diverse Samples of Older Men

Abstract

Emotional and cognitive characteristics have been studied in the context of women's cancer screening but have received scant attention in the study of men's screening behavior. Researchers know little about how such factors interact to predict screening or whether digital rectal examination (DRE) and prostate specific antigen (PSA) screens are predicted by the same characteristics. This study examines the relevance of emotional and cognitive characteristics to DRE and PSA screening among 180 U.S.-born African American, U.S.- born European American, and immigrant Jamaican men. The study identifies the expected effects in which fear is negatively related and efficacy beliefs positively related to DRE and PSA screening. Greater efficacy and (marginally) knowledge appear to "offset" the negative impact of fear on screening, and fear appears particularly relevant to DRE frequency. Results are discussed in terms of their implications for the development of health belief and self-regulatory models in the context of prostate cancer screening among minority men.

An Object Lesson: Source Determines the Relations That Trait Anxiety, Prostate Cancer Worry, and Screening Fear Hold with Prostate Screening Frequency

“…African Americans report greater fear of prostate cancer and screening, particularly for DRE (17,18), although there are exceptions (19). One study of 180 men found that both African American and Jamaican men reported greater screening fear than European Americans (20). In total, these studies suggest that minority men should report greater cancer worry and screening fear than U.S.-born European Americans.…”

“…Prostate-related anxiety may be caused by screening itself (45), men may avoid screening tests for fear of discovering prostate cancer (46,47), and concerns regarding discomfort or embarrassment may also be important (47,48). Men with greater state anxiety have been found to be more likely to drop out of a screening program (45), greater worry and concern about screening predicted self-care versus no care, although it was not related to conventional care (49), and screening fear predicted lower screening even when age, income, and education were controlled (20). Conversely, concern regarding prostate cancer has been associated with use of prostate-related complementary and alternative medicines (50) and greater trait anxiety predicted more frequent screening in a diverse group of men (27).…”

“…However, although such characteristics identify men at risk for infrequent screening, significant portions of screening variance remain; in any case, such factors are difficult to directly intervene with (20). Of the psychosocial variables considered, fears related to prostate cancer and the screening process may be among the most promising.…”

“…This view also attends to the fact that DRE and PSA tests have distinct physical and psychologic requirements (20). Specifically, although discomfort is minimal, DRE tests require that a man bend forward and allow a doctor to insert a lubricated finger into his anus.…”

“…7). Studies of other groups of Black men are few, but these too generally suggest a low rate of screening among men of African descent (20,27). Demographically, lower screening has been associated with lower education and socioeconomic status (28,29), a lack of insurance (30)(31)(32), lower age (33)(34)(35), being single (30), reports of time, access, and awareness problems (36)(37)(38), and low levels of physician recommendation (29,32,39).…”