Psychological predictors of intention and avoidance of attending organized mammography screening in Norway: applying the Extended Parallel Process Model

Abstract

Background Mammography screening is the main method for early detection of breast cancer in Norway. Few studies have focused on psychological determinants of both attendance and non-attendance of publicly available mammography screening programs. The aim of the current study, guided by the Extended Parallel Process Model, was to examine how psychological factors influence defensive avoidance of breast cancer screening and intention to attend mammography. Methods Cross-sectional survey data from a community sample of women living in Norway aged ≥ 18 (N = 270), and without a history of breast cancer, was collected from September 2018 to June 2019 and used to investigate the relationships between the Extended Parallel Process Model (EPPM) constructs and two outcomes: defensive avoidance of breast cancer screening and intention to attend mammography within the next two years. After adjusting for confounding factors, the hierarchical multiple linear regression analyses was conducted to assess the ability of the independent variables based on the EPPM to predict the two outcome variables. Significance level was chosen at p < 0.05. Results Multivariate analyses showed that defensive avoidance of breast cancer screening was predicted by lower perceived susceptibility to breast cancer (β = − 0.22, p = 0.001), lower response efficacy of mammography screening (β = − 0.33, p = 0.001), higher breast cancer fear (β = 0.15, p = 0.014), and checking breasts for lumps (β = − 0.23, p = 0.001). Intention to attend mammography within the next two years was predicted by higher response efficacy of mammography screening (β = 0.13, p = 0.032), having a lower educational level (β = − 0.10, p = 0.041), and regular previous mammography attendance compared to never attending (β = 0.49, p = 0.001). Conclusions The study revealed that defensive avoidance of breast cancer screening and intention to attend mammography were not predicted by the same pattern of psychological factors. Our findings suggest future health promotion campaigns need to focus not only on the psychological factors that encourage women’s decision to attend the screening, but also to counter factors that contribute to women’s decision to avoid it.

Factors promoting breast, cervical and colorectal cancer screenings participation: A systematic review

“…Accordingly, family history of cancer (mainly breast/cervical cancer) may significantly impact people' knowledge, attitudes, and behaviors related to screening uptake; those not having relatives who have had cancer often underestimate their own risk, thus more likely being patients who do not adhere to screening recommendations 30,72–75 . Conversely, people perceiving high susceptibility to cancer and worries linked to cancer diagnosis are more likely to participate in screening programs, since the latter are considered as potentially lifesaving (i.e., they are more likely to perceive cancer diagnosis, rather than cancer screening, as entailing the greater psychological and physical costs) 23,46,70,71,76,77 . Moreover, people perceiving high susceptibility are also more likely to repeat the test following the recommended time frames, thus the screening uptake may recall not only negative emotions, but also reassuring feelings linked to the “negative” results 23 .…”

“…Moreover, people perceiving high susceptibility are also more likely to repeat the test following the recommended time frames, thus the screening uptake may recall not only negative emotions, but also reassuring feelings linked to the “negative” results 23 . Nonetheless, research also demonstrated that an excessive amount of fear for cancer may impact people' self‐assessment of susceptibility, resulting in a defensive perception of low susceptibility and, accordingly, in active screening avoidance 77 …”

“…30,[72][73][74][75] Conversely, people perceiving high susceptibility to potentially lifesaving (i.e., they are more likely to perceive cancer diagnosis, rather than cancer screening, as entailing the greater psychological and physical costs). 23,46,70,71,76,77 Moreover, people perceiving high susceptibility are also more likely to repeat the test following the recommended time frames, thus the screening uptake may recall not only negative emotions, but also reassuring feelings linked to the "negative" results. 23 Nonetheless, research also demonstrated that an excessive amount of fear for cancer may impact people' self-assessment of susceptibility, resulting in a defensive perception of low susceptibility and, accordingly, in active screening avoidance.…”

“…23 Nonetheless, research also demonstrated that an excessive amount of fear for cancer may impact people' self-assessment of susceptibility, resulting in a defensive perception of low susceptibility and, accordingly, in active screening avoidance. 77…”

“…22,[78][79][80] In this direction, people displaying high tendency to be ego-involved in health choices (i.e., health is of high personal relevance), 70 prevention-oriented, 74,81,82 and health-aware are more likely to actively engage in cancer screening programs. 76,77 Similarly, positive attitude towards the benefits of screening, 83 perceived control in personal choices and over own health, 81,84 personal motivation, 33,70,74 high perceived self-efficacy and response efficacy 77 are pivotal features promoting screening adherence, that enhance the search of adequate information about cancer screening and that support the willingness to overwhelm the perceived barriers to cancer screening.…”