Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: a cross-sectional survey

Authors: Danika Marmarà, Vincent Marmarà, Gill Hubbard

Published in: BMC Public Health | Issue 1/2017

Login to get access

Abstract

Background

Women’s beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. This study utilized the health belief model (HBM) and common-sense model (CSM) of illness self-regulation to explore factors associated with BS uptake in Malta and subsequently, to identify the most important predictors to first screening uptake.

Methods

This cross-sectional survey enrolled Maltese women (n = 404) ages 50 to 60 at the time of their first screening invitation, invited to the National Breast Screening Programme by stratified random sampling, with no personal history of BC. Participants responded to a 121-item questionnaire by telephone between June–September 2015. Data were analyzed using descriptive statistics, chi-square tests and logistic regression.

Results

There is high awareness of BC signs and symptoms among Maltese women (>80% agreement for 7 out of 8 signs), but wide variation about causation (e.g., germ or virus: 38.6% ‘agree’, 30.7% ‘disagree’). ‘Fear’ was the key reason for non-attendance to first invitation (41%, n = 66) and was statistically significant across all subscale items (p < 0.05). Most items within HBM constructs (perceived barriers; cues to action; self-efficacy) were significantly associated with first invitation to the National Breast Screening Programme, such as fear of result (χ2 = 12.0, p = 0.017) and life problems were considered greater than getting mammography (χ2 = 38.8, p = 0.000). Items within CSM constructs of Illness Representation (BC causes; cyclical cancer timeline; consequences) were also significantly associated, such as BC was considered to be life-changing (χ2 = 18.0, p = 0.000) with serious financial consequences (χ2 = 13.3, p = 0.004). There were no significant associations for socio-demographic or health status variables with uptake, except for family income (χ2 = 9.7, p = 0.047). Logistic regression analyses showed that HBM constructs, in particular perceived barriers, were the strongest predictors of non-attendance to first invitation throughout the analyses (p < 0.05). However, the inclusion of illness representation dimensions improved the model accuracy to predict non-attendance when compared to HBM alone (65% vs 38.8%).

Conclusions

Interventions should be based on theory including HBM and CSM constructs, and should target first BS uptake and specific barriers to reduce disparities and increase BS uptake in Malta.
Appendix
Available only for authorised users
Literature
1.
Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H, et al. Cancer incidence and mortality in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49:1374–403.CrossRefPubMed
2.
Ferlay J, Héry C, Autier P, Sankaranarayanan R. Global burden of breast cancer. In: Li CI, editor. Breast cancer epidemiology. Springer; 2010. p. 1–19.
3.
4.
5.
Dang J, Lee J, Tran JH. Knowledge, attitudes and beliefs regarding breast and cancer screening among Cambodian, Laotian, Thai and Tongan women. J Cancer Educ. 2010;25:595–601.CrossRefPubMedPubMedCentral
6.
Mamdouh HB, El-Mansy H, Kharboush IF, Ismail HM, Tawfik MM, El-Baky MA, et al. Barriers to breast cancer screening among a sample of Egyptian females. J Family Comm Med. 2014;21(2):119–24.CrossRef
7.
Greif J. Mammographic screening for breast cancer: an invited review of the benefits and costs. Breast. 2010;19:268–72.CrossRefPubMed
8.
Mai V, Sullivan T, Chiarelli AM. Breast cancer screening program in Canada: successes and challenges. Salud Publica Mex. 2009;51(Suppl 2):s228–35.CrossRefPubMed
9.
Schopper D, de Wolf C. How effective are breast cancer screening programmes by mammography? Review of the current evidence. Eur J Cancer. 2009;45:1916–23.CrossRefPubMed
10.
Steele CB, Rim SH, Joseph DA, King JB, Seeff LC. Centers for Disease Control and Prevention (CDC). Colorectal cancer incidence and screening - United States, 2008 and 2010. MMWR Suppl. 2013;62(3):53–60.PubMed
11.
Chaudhry R, Scheitel SM, McMurtry EK, Leutink DJ, Cabanela RL, Naessens JM, et al. Web-based proactive system to improve breast cancer screening: a randomized controlled trial. Arch Intern Med. 2007;167:606–11.CrossRefPubMed
12.
Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L. European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition – summary document. Ann Oncol. 2008;19(4):614–22.CrossRefPubMed
13.
14.
Marmarà DM, Curtis J, Marmarà VA. Women’s satisfaction of the Maltese breast screening Programme: a cross-sectional survey. Malta Med J. 2015;27(4):13–21.
15.
Whelehan P, Evans A, Wells M, MacGillivray S. The effect of mammography pain on repeat participation in breast cancer screening: a systematic review. Breast. 2013;22:389–94.CrossRefPubMed
16.
Jepson R, Clegg A, Forbes C, Lewis R, Sowden A, Kleijnen J. The determinants of screening uptake and interventions for increasing uptake: a systematic review. Health Technol Assess. 2000;4(14:i-vii):1–133.
17.
Anagnostopoulos F, Dimitrakaki C, Fitzsimmons D, Potamianos G, Niakas D, Tountas Y. Health beliefs and illness perceptions as related to mammography uptake in randomly selected women in Greece. J Clin Psychol Med Settings. 2012;19:147–64.CrossRefPubMed
18.
Champion VL, Monahan PO, Springston JK, Russell K, Zollinger TW, Saywell RM Jr, et al. Measuring mammography and breast cancer beliefs in African American women. J Health Psychol. 2008;13:827–37.CrossRefPubMedPubMedCentral
19.
Huaman MA, Kamimura-Nishimura KI, Kanamori M, Siu A, Lescano AG. Validation of a susceptibility, benefits, and barrier scale for mammography screening among Peruvian women: a cross-sectional study. BMC Womens Health. 2011;11:54.CrossRefPubMedPubMedCentral
20.
Mosleh SM, Almalik MM. Illness perception and adherence to healthy behaviour in Jordanian coronary heart disease patients. Eur J Cardiovasc Nurs. 2016;15(4):223–30.CrossRefPubMed
21.
Petrak A, Sherman KA, Fitness J. Validation of the Croatian and Lebanese revised illness perception questionnaires for healthy people (IPQ-RH). Eur J Cancer Care. 2015;24:355–66.CrossRef
22.
Liu L-Y, Wang F, Yu L-X, Ma Z-B, Zhang Q, Gao D-Z, et al. Breast cancer awareness among women in eastern China: a cross-sectional study. BMC Public Health. 2014;14:1004.CrossRefPubMedPubMedCentral
23.
Dundar PE, Özmen D, Öztürk B, Haspolat G, Akyildiz F, Çoban S, et al. The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in western Turkey. BMC Cancer. 2006;6:43.CrossRefPubMedPubMedCentral
24.
Walsh B, Silles M, O’Neill C. The importance of socio-economic variables in cancer screening participation: a comparison between population-based and opportunistic screening in the EU-15. Health Policy. 2011;101(3):269–76.CrossRefPubMed
25.
Meissner HI, Smith RA, Rimer BK, Wilson KM, Rakowski W, Vernon SW, et al. Promoting cancer screening: learning from experience. Cancer. 2004;101(5 Suppl):1107–17.CrossRefPubMed
26.
Cohen M, Azaiza F. Increasing breast examinations among Arab women using a tailored culture based intervention. Behav Med. 2010;36:92–9.CrossRefPubMed
27.
Meissner HI, Breen N, Taubman ML, Vernon SW, Graubard BI. Which women aren’t getting mammograms and why? (United States). Cancer Causes Control. 2007;18:61–70.CrossRefPubMed
28.
Jahanlou AS, Lotfizade M, Karami NA. A New Behavioral Model (Health Belief Model Combined with Two Fear Models): Design, Evaluation and Path Analysis of the Role of Variables in Maintaining Behavior. InTech. 2013. http://​dx.​doi.​org/​10.​5772/​52966. Accessed 9 Sept 2016.
29.
Orji R, Vassileva J, Mandryk R. Towards an effective health interventions design: an extension of the health belief model. Online J Public Health Inform. 2012;4(3):e9.CrossRef
30.
Baines T, Wittkowski A. A systematic review of the literature exploring illness perceptions in mental health utilising the self-regulation model. J Clin Psychol Med Settings. 2013;20(3):263–74.CrossRefPubMed
31.
Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised illness perception questionnaire (IPQ-R). Psychol Health. 2002;17:1–16.CrossRef
32.
Charkazi A, Samimi A, Razzaghi K, Kouchaki GM, Moodi M, Meirkarimi K, et al. Adherence to recommended breast cancer screening in Iranian Turkmen women: the role of knowledge and beliefs. ISRN Prevent Med. 2013; http://​dx.​doi.​org/​10.​5402/​2013/​581027. Accessed 15 Sept 2016
33.
34.
Allen J, Stoddard AM, Sorensen GC. Do social network characteristics predict mammography screening practices? Health Educ Behav. 2008;35(6):763–76.CrossRefPubMed
35.
Wübker A. Explaining variations in breast cancer screening across European countries. Eur J Health Econ. 2014;15(5):497–514.CrossRefPubMed
36.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335:806–8.CrossRef
37.
Maltatoday. Women still shy away from free cancer screening. 2013. http://​maltatoday.​uberflip.​com/​i/​224217-mt-8-december-2013/​55.​ Accessed 20 Aug 2016.
38.
Menold N, Zuell C. Reasons for refusals, their collection in surveys and interviewer impact. GESIS-working papers 2010/11, Mannheim. 2010. Available at:http://​www.​gesis.​org/​fileadmin/​upload/​forschung/​publikationen/​gesis_​reihen/​gesis_​arbeitsberichte/​Working_​Paper_​2010_​11_​online.​pdf.​ Accessed 29 December 2016.
39.
Hersch J, Barratt A, Jansen J, Houssami N, Irwig L, Jacklyn G, et al. The effect of information about overdetection of breast cancer on women’s decision-making about mammography screening: study protocol for a randomised controlled trial. BMJ Open. 2014;4:e004990. doi:10.​1136/​bmjopen-2014-004990.CrossRefPubMedPubMedCentral
40.
Chambers JA, O’Carroll RE, Cook A, Cavanagh J, Archibald D, Millar R. A pilot telephone intervention to increase uptake of breast cancer screening in socially deprived areas in Scotland (TELBRECS): study protocol for a randomised controlled trial. BMC Public Health. 2014;14:824. doi:10.​1186/​1471-2458-14-824.CrossRefPubMedPubMedCentral
41.
Sturges JE, Hanrahan KJ. Comparing telephone and face-to-face qualitative interviewing: a research note. Qual Res. 2004;4:107–18.CrossRef
42.
Fair AM, Wujcik D, Lin J-MS, Egan KM, Grau AM, Zheng W. Timing is everything: methodologic issues locating and recruiting medically underserved women for abnormal mammography follow-up research. Contemp Clin Trials. 2008;29(4):537–46.CrossRefPubMedPubMedCentral
43.
Champion VL. Revised susceptibility, benefits, and barriers scale for mammography screening. Res Nurs Health. 1999;22(4):341–8.CrossRefPubMed
44.
Guvenc I, Guvenc G, Tastan S, Akyuz A. Identifying women’s knowledge about risk factors of breast cancer and reasons for having mammography. Asian Pac J Canc Prev. 2012;13(8):4191–7.CrossRef
45.
Dandash KF, Al-Mohaimeed A. Knowledge, attitudes, and practices surrounding breast cancer and screening in female teachers of Buraidah, Saudi Arabia. Int J Health Sci (Qassim). 2007;(1):1, 61–71.
46.
Han PKJ, Kobrin SC, Klein WMP, Davis WW, Stefanek M, Taplin SH. Perceived ambiguity about screening mammography recommendations: association with future mammography uptake and perceptions. Cancer Epidemiol Biomarkers Prev. 2007;16:458–66.CrossRefPubMed
47.
48.
Ritvo P, Edwards SA, Glendon G, Mirea L, Knight JA, Andrulis IL, et al. Beliefs about optimal age and screening frequency predict breast screening adherence in a prospective study of female relatives from the Ontario site of the breast cancer family registry. BMC Public Health. 2012;12:518. doi:10.​1186/​1471-2458-12-518.CrossRefPubMedPubMedCentral
49.
50.
51.
Vahabi M. Knowledge of breast cancer and screening practices. Health Educ J. 2005;64:218–28.CrossRef
52.
Gozum S, Karayurt O, Kav S, Platin N. Effectiveness of peer education for breast cancer screening and health beliefs in eastern Turkey. Cancer Nurs. 2010;33:213–20.CrossRefPubMed
53.
Dundar PE, Ozyurt BC, Erdurak K. Sociodemographic determinants of nonattendance in a population-based mammography screening program in the City of Manisa, Turkey. Sci World J. 2012:1–14.
54.
55.
56.
Aro AR, de Koning HJ, Absetz P, Schreck M. Two distinct groups of non-attenders in an organized mammography screening program. Breast Cancer Res Treat. 2001;70(2):145–53.CrossRefPubMed
57.
Lagerlund M, Sparén P, Thurfjell E, Ekbom A, Lambe M. Predictors of non-attendance in a population-based mammography screening programme; socio-demographic factors and aspects of health behaviour. Eur J Cancer Prev. 2000;9(1):25–33.CrossRefPubMed
58.
Carney P, O’Neill S, O’Neill C. Determinants of breast cancer screening uptake in women, evidence from the British household panel survey. Soc Sci Med. 2013;82:108–14.CrossRefPubMed
59.
Trigoni M, Griffiths F, Tsiftsis D, Koumantakis E, Green E, Lionis C. Mammography screening: views from women and primary care physicians in Crete. BMC Womens Health. 2008;8:20.CrossRefPubMedPubMedCentral
60.
Moodi M, Rezaeian M, Mostafavi F, Sharifirad G-R. Determinants of mammography screening behavior in Iranian women: a population-based study. J Res Med Sci. 2012;17(8):750–9.PubMedPubMedCentral
61.
Hatefnia E, Niknami S, Bazargan M, Mahmoodi M, Lamyianm M, Alavi N. Correlates of mammography utilization among working Muslim Iranian women. Health Care Women Int. 2010;31:499–514.CrossRefPubMed
62.
Farmer D, Reddick B, D’Agostino R, Jackson SA. Psychosocial correlates of mammography screening in older African American women. Oncol Nurs Forum. 2007;34:117–23.CrossRefPubMed
63.
Secginli S, Nahcivan N. Factors associated with breast cancer screening behaviours in a sample of Turkish women: a questionnaire survey. Int J Nurs Stud. 2006;43:161–71.CrossRefPubMed
64.
Tolma EL, Reininger BM, Ureda J. What predicts a Cypriot woman's decision to obtain or not obtain a screening mammogram? Implications for the promotion of screening mammography in Cyprus. Eur J Cancer Prev. 2006;15:149–57.CrossRefPubMed
65.
Avci IA, Kurt H. Health beliefs and mammography rates of Turkish women living in rural areas. J Nurs Scholarsh. 2008;40:170–5.CrossRefPubMed
66.
Soskolne V, Marie S, Manor O. Beliefs, recommendations and intentions are important explanatory factors of mammography screening behavior among Muslim Arab women in Israel. Health Educ Res. 2007;22(5):665–76.CrossRefPubMed
67.
Aiken LS, West SG, Woodward CK, Reno RR. Health beliefs and compliance with mammography – screening recommendations in asymptomatic women. Health Psychol. 1994;13:122–9.CrossRefPubMed
68.
Cohen M. Breast cancer early detection, health beliefs, and cancer worries in randomly selected women with and without a family history of breast cancer. Psycho-Oncology. 2006;15:873–83.CrossRefPubMed
69.
Parsa P, Kandiah M, Abdul Rahman H, Zulkefli NM. Barriers for Breast Cancer Screening among Asian women: A Mini Literature Review. Asian Pacific J Cancer Prev. 2006;7:509–14.
70.
Fayanju OM, Kraenzle S, Drake BF, Oka M, Goodman MS. Perceived barriers to mammography among underserved women in a breast health center outreach program. Am J Surg. 2014;208(3):425–34.CrossRefPubMedPubMedCentral
71.
Consedine NS, Magai C, Krivoshekova YS, Ryzewicz L, Neugut AI. Fear, anxiety, worry, and breast cancer screening behavior: a critical review. Cancer Epidemiol Biomarkers Prev. 2004;13(4):501–10.PubMed
72.
73.
Austin LT, Ahmad F, McNally M-J, Stewart DE. Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model. Womens Health Issues. 2002;12(3):122–8.CrossRefPubMed
74.
Hagger MS, Orbell S. A meta-analytic review of the common-sense model of illness representations. Psychol Health. 2003;18(2):141–84.CrossRef
75.
Pascal J-P, Hendren S, Fiscella K, Loader S, Rousseau S, Schwartzbauer B. Understanding the processes of patient navigation to reduce disparities in cancer care: perspectives of trained navigators from the field. J Cancer Educ. 2011;26:111–20.CrossRef
76.
77.
Donnelly TT, Al Khater AH, Al-Bader SB, Al Kuwari MG, Al-Meer N, Malik M, et al. Beliefs and attitudes about breast cancer and screening practices among Arab women living in Qatar: a cross-sectional study. BMC Womens Health. 2013;13:49.CrossRefPubMedPubMedCentral
78.
79.
80.
Lagerlund M, Maxwell AE, Bastani R, Thurfjell E, Ekbom A, Lambe M. Sociodemographic predictors of non-attendance at invitationalmammography screening–a population-based register study (Sweden). Cancer Causes Control. 2002;13(1):73–82.CrossRefPubMed
81.
Cuthbertson SA, Goyder EC, Poole J. Inequalities in breast cancer diagnosis in the Trent region and implications for the NHS breast screening Programme. J Public Health. 2009;31(3):398–405.CrossRef
82.
Bridle C, Riemsma RP, Pattenden J, Sowden AJ, Mather L, Watt IS, et al. Systematic review of the effectiveness of health behavior interventions based on the transtheoretical model. Psychol Health. 2005;20(3):283–301.CrossRef
83.
Wyke S, Adamson J, Dixon D, Hunt K. Consultation and illness behaviour in response to symptoms: a comparison of models from different disciplinary frameworks and suggestions for future research directions. Soc Sci Med. 2013;86:79–87.CrossRefPubMed
84.
Lunt J, Bowen J, Lee R. HSE review of the risk prevention approach to occupational health: applying models to 21st century occupational health needs: health models information pack (HSL/2005/57). London: Health & Safety Executive/Health & Safety Laboratory; 2005. http://​www.​hse.​gov.​uk/​research/​hsl_​pdf/​2007/​hsl0724.​pdf.​ Accessed 25 May 2016
85.
Kalsta A, Holloway A, Cox K. Factors that influence mammography screening behaviour: a qualitative study of Greek Women’s experiences. Eur J Oncol Nurs. 2013;17(3):292–301.
86.
Rutter DR, Calnan M, Field S, Vaile MSB. Predicting reattendance in the second round of the UK National Breast Screening Programme: a prospective 3-year longitudinal analysis. Breast. 1997;6(3):120–5.CrossRef
87.
Rauscher G, O’Malley M, Earp JA. How consistently do women report lifetime mammograms at successive interviews? Am J Prev Med. 2002;22(1):8–14.CrossRefPubMed
Metadata
Title
Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: a cross-sectional survey
Authors
Danika Marmarà
Vincent Marmarà
Gill Hubbard
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4324-6

Other articles of this Issue 1/2017

BMC Public Health 1/2017 Go to the issue

Erratum

Erratum to: systematic review and meta-analysis of the effect of increased vegetable and fruit consumption on body weight and energy intake

Research article

Exposure to hepatitis C virus in homeless men in Central Brazil: a cross-sectional study

Research article

Self-rated health and perceived violence in the neighborhood is heterogeneous between young women and men

Research article

Designing equitable workplace dietary interventions: perceptions of intervention deliverers

Study protocol

Study protocol for “MOVEdiabetes”: a trial to promote physical activity for adults with type 2 diabetes in primary health care in Oman

Debate

Malaria control by commodities without practical malariology