Individually elicited versus modal normative beliefs in predicting attendance at breast screening: Examining the role of belief salience in the Theory of Planned Behaviour

Abstract

OBJECTIVE: To examine the influence of an individually derived versus modal subjective norm component of the Theory of Planned Behaviour (TPB) in predicting attendance at breast screening. DESIGN: A prospective, longitudinal design was employed using a postal questionnaire at Time 1 and objective attendance data from screening records at Time 2. METHOD: Questionnaires were sent to 1000 women from East Kent due to be invited for X-ray mammography under the UK's National Health Service Breast Screening Programme. The TPB constructs were used to predict attendance, with a focus on subjective norm. Two versions of the questionnaire were distributed: one assessed subjective norm using individually generated normative beliefs (individual condition) and the other provided a list of modal referents (modal condition). RESULTS: The mean number of normative referents in the individual condition was just two, almost all of whom were family members, in contrast to the modal condition where 'GP' led the rank table. The results suggest that a more senstive measure of subjective norm is attained using individually derived beliefs. Structural equation modelling revealed that, contrary to theoretical prediction, the effect on attendance of the individually derived subjective norm was not entirely mediated by intention: an independent contribution to attendance was shown. In the modal condition the construct was entirely mediated by intention. CONCLUSIONS: For health behaviours that have implications for others as well as self, measuring individually salient normative beliefs may both improve theoretical prediction and yield information of potential value for designing intervention programmes.

Mammography Screening and the Theory of Planned Behavior: Suggestions Toward an Extended Model of Prediction

“…In most studies regarding mammography screening, results were consistent with this assumption, and control measures were found to strongly and independently predict behavior (Drossaert, Boer, & Seydel, 2003;Montano & Taplin, 1991) and intention (Godin et al, 2001;Steele & Porche, 2005;Montano et al, 1997;Steadman & Rutter, 2004). The studies that did not report a strong perceived behavioral control effect, examined novel behaviors (Rutter, 2000;Steadman et al, 2002;Tolma et al, 2003) in that none of the study participants ever had a mammogram before. As perceived behavioral control has been found to have a low contribution in predicting unfamiliar behaviors (Sheeran, Conner, & Norman, 2001), a weak perceived control is not an unexpected finding.…”

“…Consistent with the TPB, intention was found to be the strongest predictor of participation in mammography screening for the studies that measured actual behavior (Drossaert, Boer, & Seydel, 2003;Montano & Taplin, 1991;Rutter, 2000;Steadman & Rutter, 2004;Steadman, Rutter, & Field, 2002) and self-reported behavior (Montano et al, 1997;Steel & Porche, 2005).…”

“…As the theory postulates, attitude reportedly predicted intention in all studies except one, thus emerging as the strongest among TPB predictors in the majority of findings (Drossaert, Boer, & Seydel, 2003;Montano & Taplin, 1991;Rutter, 2000;Steadman, Rutter, & Field, 2002;Steadman & Rutter, 2004). In the study by Godin et al (2001), attitude was reported to have a minor contribution in predicting mammography intention.…”

Intentions to Maintain Adherence to Mammography

“…47 Only a subset of these variables significantly predicted implementation intentions. Expressing complete behavioral control and reporting one barrier, as opposed to no barriers, were related to women having thought about where to get their next mammograms.…”

Personal Background and Cognitive Factors as Predictors of the Intention to be Screened for Stomach Cancer

“…Insight about factors that facilitate or impede participation in the stomach cancer screening program may be helpful in improving participation rates. Most studies conducted in other countries have focused on participation in breast (8)(9)(10)(11)(12)(13)(14)(15) or prostate cancer (16,17) screening programs, which is one reason that these two cancers are the most frequently diagnosed in both women and men. Given that stomach cancer is the leading cause of cancer death in Korea, this study focused on the intention to receive stomach cancer screening.…”