Health Behavioural Theories and Their Application to Women's Participation in Mammography Screening

Abstract

The most effective method of detecting breast cancer among asymptomatic women is by mammography screening. Most countries have this preventive measure in place for women within their society; however, most of these programs struggle with attendance. This article discusses four health behavioural theories and models in relation to mammography screening that may explain the factors affecting women's participation, including the health belief model, theory of planned behaviour, trans-theoretical model, and the theory of care seeking behaviour. In summary, analysis of these theories indicates that the theory of care seeking behaviour has value for exploring these factors because of its sensitivity to socioeconomic differences that exist among women in society and because it has a broader construct (such as habit and external factors) compared to the other health behavioural theories.

Résumé

La mammographie de dépistage est la méthode la plus efficace pour la détection du cancer du sein chez les femmes asymptomatiques. Bien que cette méthode de détection soit en place dans la plupart des pays, la plupart de ces programmes continuent d'avoir de la difficulté à susciter la participation des femmes. Cet article présente quatre théories et modèles comportementaux en santé, en lien avec la mammographie de dépistage, incluant le modèle des croyances en matière de santé, la théorie du comportement planifié, le modèle trans-théorique et la théorie de la recherche des soins, qui peuvent expliquer les facteurs ayant une incidence sur la participation des femmes aux programmes de mammographie de dépistage. Ceci résulte de la sensibilité aux différences socio-économiques qui existent entre les femmes dans la société et de la présence d'un construct plus large (comme l'habitude et les facteurs externes) comparativement aux autres théories comportementales en matière de santé.

Introduction

Breast cancer is the leading cause of death among women worldwide [1]. It is the second most common cancer, with about 1.7 million new cases diagnosed worldwide in 2012 [2]. The incidence of breast cancer varies in different geographical locations, with Western Europe reporting the highest incidence and middle Africa reporting the lowest incidence [1]. Higher mortality rates, however, are found within the African continent, with more than half of the women found to have had breast cancer dying of the condition [1]. The high mortality rate in these regions could be associated with factors such as late presentation for diagnosis and treatment; inadequate diagnostic and treatment facilities; and poor knowledge of and lack of participation in the breast cancer screening programs, where available [3].

For a screening program to be effective in reducing the mortality rate of women with breast cancer, it has to record both a high participation rate and a high detection rate of breast lesions [4]. However, even developed nations with established mammography screening programs struggle to encourage attendance. The UK Health and Social Care Information Centre [5] shows that even with the UK Government's effort to ensure that at least 70% of eligible women participate regularly in the mammography screening program, this target has not been achieved among women living in London, with the black population being under-represented [6]. The issue of some minority groups being under-represented in mammography screening programs has also been reported in several other studies conducted in the United States [7], though the screening programs in these countries cannot be directly compared because of the varied characteristics of these programs [8].

The aim of this article is to explore a range of health behavioural theories that could be applied to mammography screening. Health behaviour theories have been developed to predict reasons why people choose to participate or not participate in health promotion programs. However, only a few of these theories have relevance to mammography screening because of their construct validity [9], [10], [11] because many of them were developed for different settings and purposes. Understanding the relative merits and limitations of these theories might inform future mammography participation research design, and application of strategies supported by these theories within mammography screening programs might also improve women's participation.

Painters et al [12] identify that the health belief model, trans-theoretical model, theory of planned behaviour, and social cognitive theory are the most frequently used health behavioural theories. However, an additional theory, the theory of care seeking behaviour, was developed specifically to explore the factors affecting women's participation in mammography screening programs [13], [14]. The health behaviour theories can be classified into two groups: the first group focuses on how individual factors predict a person's health behaviour and the second group focuses on how society influences a person's health behaviour. In this second group lies the social cognitive theory focusing on how the society, social interactions, and the media influence an individual's participation in a health promotion program. However, this article provides an overview of the four other theories that focus on individual, rather than societal factors to predict or explain women's health behaviour, in the context of mammography screening.