The application of health behavior theories to promote cervical cancer screening uptake

Abstract

Background: While cervical cancer is a major cause of mortality, its progress and survival rate can be improved through screening. Yet despite their wide availability, women's participation in cervical cancer screening (CCS) programs is often suboptimal, especially in low-and middle-income countries. Besides demographic and organizational characteristics, screening uptake is influenced by psychological factors, most of which are included in health behavior theories. This systematic review compared different health behavior theories in terms of their capacity to explain CCS uptake and inform CCS promotion campaigns. Methods: A comprehensive search and analysis of published intervention and nonintervention (observational) studies that applied at least one health behavior theory to CCS participation. Results: After quality screening, 48 observational and 21 intervention studies were identified that applied the Health Belief Model (HBM), Theory of Reasoned Action (TRA), Theory of Planned Behaviour (TPB), Transtheoretical model (TTM), Socialecological Model (SEM), and/or Theory of Triadic Influence (TTI) to CCS. The HBM was most frequently used to explain behavior, whereas the TPB was better at explaining screening intentions. Tailored intervention studies focusing on all theoretical constructs were most effective in modifying perceptions and increasing CCS uptake. Conclusions: Despite their inconsistent use, health behavior theories can explain CCS intentions and behavior and contribute to the development of targeted interventions to promote screening uptake. K E Y W O R D S beliefs, cancer, health behavior theories, health behaviors, interventions, public health nursing education, screening, women's health 1 BACKGROUND Cancer of the cervix uteri is the fourth most common cancer among women worldwide, and accounts for 7.5% of all female cancer deaths (Ferlay et al., 2015). The projected number of deaths due to cervical cancer by 2030 is estimated at approximately 80%, with the highest mortality occurring in low-middle-income countries (LMICs). While vaccination is increasingly practiced in economically developed countries, most LMICs restrict cancer prevention to screening. Screening helps to detect and treat infections that may progress into cancer at an early stage, which results in a better prognosis and higher survival rate (Edge & Compton, 2010). Yet, despite the wide availability of screening, the participation of women in CCS programs is often suboptimal, especially in LMICs (Islam et al., 2017).

A comparison of behavioural models explaining cervical cancer screening uptake

“…The survey questionnaire was developed based on a systematic review [36], a qualitative study [18] and a validation study conducted in the context [37]. In addition to socio-demographic characteristics, it measured the key 5 constructs of the HBM (perceived susceptibility, perceived severity, perceived benefits, perceived barriers and perceived self-efficacy), 3 constructs of the TPB (attitude, subjective norm and perceived behavioural control), and 4 constructs of the TCSB (affect, utility, norms and habits).…”

A health action process approach for developing invitee endorsed interventions to increase mail‐out bowel cancer screening

“…The findings from the UR‐MSI scale indicate that providing information regarding the invitee's elevated risks of bowel cancer, sending text message‐based reminders and providing alternative locations to return their FOBT kit should be incorporated into mail‐out FOBT screening programmes to increase participation. However, for interventions to have the greatest effect on participation rates, a multifaceted approach that targets all aspects of the HAPA model is likely required (Dsouza et al, 2021; Glanz & Bishop, 2010). A summary of a multifaceted consumer‐informed behaviour change strategy based on the current findings is shown in Figure 2.…”

“…Designing interventions based on psychological theory, especially when targeting multiple components of that theory, has been shown to be an effective method for addressing behaviour change (Dsouza et al, 2021; Glanz & Bishop, 2010). For example, interventions based on the theory of planned behaviour constructs, including attitudes, subjective norms, perceived behavioural control and intentions, have increased cervical cancer screening behaviour (Dsouza et al, 2021). So far, developers of interventions aiming to increase participation in mail‐out bowel cancer screening programmes rarely report basing their design on psychological theory (Myers, Goodwin, March, & Dunn, 2020).…”

“…There are often multiple determinants that affect the uptake of a health behaviour, for example, peoples' attitudes, knowledge and reactions to stress (Glanz & Bishop, 2010). Psychological theories, such as the theory of planned behaviour or the health belief model, can be used to describe what the main determinants of health behaviours are and guide intervention design (Dsouza et al, 2021). Designing interventions based on psychological theory, especially when targeting multiple components of that theory, has been shown to be an effective method for addressing behaviour change (Dsouza et al, 2021; Glanz & Bishop, 2010).…”

“…Psychological theories, such as the theory of planned behaviour or the health belief model, can be used to describe what the main determinants of health behaviours are and guide intervention design (Dsouza et al, 2021). Designing interventions based on psychological theory, especially when targeting multiple components of that theory, has been shown to be an effective method for addressing behaviour change (Dsouza et al, 2021; Glanz & Bishop, 2010). For example, interventions based on the theory of planned behaviour constructs, including attitudes, subjective norms, perceived behavioural control and intentions, have increased cervical cancer screening behaviour (Dsouza et al, 2021).…”