Testing theoretical explanations of mammography use

Research Guided by the Theory of Care-Seeking Behavior: A Scoping Review

BACKGROUND

A particular Theory of Care-Seeking Behavior was developed to explain care-seeking behavior with psychosocial concepts, external conditions, and clinical and demographic factors. Having a careful review of studies based on this theory could guide future research on care-seeking behaviors.

OBJECTIVES

With a scoping review: describe characteristics of studies guided by a Theory of Care-Seeking Behavior, summarize support for the relationships of proposed, explanatory variables with care-seeking behaviors, and examine support for propositions in the theory.

METHOD

Searching 5 electronic databases, we sought studies that were: full-text, peer-reviewed, in English, data-based, guided by the theory, and published from January 1, 1992, to January 1, 2022.

RESULTS

Across 18 identified articles, the behaviors studied included: symptomatic screening (n = 8), asymptomatic screening (n = 7), and care-seeking behaviors for either screening or symptoms (n = 3). A total of 3328 adults participated in the studies. In 16 studies, all participants were female. In 60% to 83% of studies, researchers had reported findings that supported the relationships of explanatory concepts with care-seeking behavior. Among the 7 studies that tested the 2 propositions of theory, all 7 tests failed to support the proposition that clinical and demographic factors influence care-seeking behavior indirectly through psychosocial variables. Six tests supported the proposition that psychosocial variables influence behavior conditionally, on external conditions.

CONCLUSIONS

Relationships of these explanatory variables with care-seeking behaviors were supported, as was 1 of 2 propositions. The Theory of Care-Seeking Behavior can be applied to new clinical situations to continue to build knowledge of the theory and understanding of care-seeking behaviors.

A comparison of behavioural models explaining cervical cancer screening uptake

BACKGROUND

Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention.

METHODS

A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models.

RESULTS

CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers.

CONCLUSION

Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women's screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.

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

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.

Early Detection Measures for Cancer in Family Caregivers of Minority Women: An Educational Program

Family caregiving is an essential part of our health care system. Family caregivers are often neglected. Because the majority of caregivers are women, special attention should be given to these women. Caregiving women require education and guidance to support them not only in caregiving roles but also in taking care of their health. The purpose of this article is to educate family caregivers about early detection and screening measures for two common forms of cancer among minority women. Specifically, this article presents an educational program that serves as guidelines for home care nurses to educate family caregivers to practice early detection for both breast and cervical cancer. It is agreed that to design an effective educational program for family caregivers, home health nurses have to take into consideration the various barriers to breast cancer screening, including personal, sociodemographic, and external barriers.

Competitive testing of health behavior theories: how do benefits, barriers, subjective norm, and intention influence mammography behavior?

BACKGROUND

Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories.

PURPOSE

We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior.

METHODS

We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n = 704). We compared direct, partial mediation, and full mediation models with Satorra-Bentler χ (2) difference testing.

RESULTS

Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers.

CONCLUSIONS

Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography.

Relationship between expanded health belief model variables and mammography screening adherence in women with multiple sclerosis: a pilot study

People with disabilities often find it more difficult to access health-care services than the general population, further jeopardizing their health and well-being. The purpose of this descriptive pilot study was to explore the relationship between variables of the Expanded Health Belief Model (EHBM) and adherence to mammography screening in a sample of homebound women with MS after completion of a National Multiple Sclerosis Society (NMSS) intervention, known as the "Home-Based Health Maintenance Program for Women with MS," that was conducted in Allegheny County, Pennsylvania. The intervention was conducted in the patients' homes and included education of the women and their partners on risk factors for breast cancer and instruction in breast examination techniques. The patients were also helped to make appointments for mammograms. This study derived its sample from the intervention program and used data on adherence recorded by the NMSS. After completion of the intervention, telephone interviews were conducted with women who met the inclusion criteria (N = 11). Descriptive statistics indicate that adherence can be successfully described using variables of the EHBM, including perceived susceptibility, perceived severity, perceived benefits, and self-efficacy. The instruments chosen for the research were well tolerated, useful, and efficient to administer and allowed for immediate assessment.

Women weigh in: obese African American and White women's perspectives on physicians' roles in weight management

BACKGROUND

There is little qualitative research on the type of weight loss counseling patients prefer from their physicians and whether preferences differ by race.

METHODS

This qualitative study used semistructured, in-depth interviews of 33 moderately to severely obese white and African American women to elucidate and compare their perceptions regarding their primary care physician's approach to weight loss counseling. Data were analyzed using a grounded theory approach and a series of immersion/crystallization cycles.

RESULTS

White and African American women seemed to internalize weight stigma differently. African American participants spoke about their pride and positive body image, whereas white women more frequently expressed self-deprecation and feelings of depression. Despite these differences, both groups of women desired similar physician interactions and weight management counseling, including (1) giving specific weight loss advice and individualized plans for weight management; (2) addressing weight in an empathetic, compassionate, nonjudgmental, and respectful manner; and (3) providing encouragement to foster self-motivation for weight loss.

CONCLUSION

While both African American and white women desired specific strategies from physicians in weight management, some white women may first need assistance in overcoming their stigma, depression, and low self-esteem before attempting weight loss.

Understanding Hmong women's beliefs, feelings, norms, and external conditions about breast and cervical cancer screening

OBJECTIVES

To describe the beliefs, feelings, norms, and external conditions regarding breast and cervical cancer screening in a sample of Hmong women.

DESIGN AND SAMPLE

In a descriptive design, female Hmong researchers recruited 16 Hmong women (ages 24-73) at a community center. Guided by the Theory of Care Seeking Behavior (TCSB), researchers asked participants semi-structured questions about their beliefs, feelings, norms, and external conditions in a group setting. Researchers documented responses in writing and audio recordings. Guided by theory, we used directed content analysis to categorize responses.

RESULTS

Participants' beliefs' about screening included uncertainty about causes of breast and cervical cancer, uncertainty about Western forms of treatments, and terminal illness as outcomes of such cancer. Many felt embarrassed about breast and cervical cancer screening. Their cultural norms about undressing for an exam and listening to authority figures were different from Western norms. External conditions that influenced participants' for screenings included difficulties in communicating with interpreters and clinicians.

CONCLUSIONS

Consistent with the TCSB, Hmong women's beliefs, affect, cultural norms and external conditions helped to understand their use of breast and cervical screening. Findings could guide nursing and public health interventions to improve culturally sensitive, cancer screening for Hmong women.

Obese women's barriers to mammography and pap smear: the possible role of personality

Obese women are at increased risk of developing and dying from cancer, but are less likely than nonobese women to receive cancer screening examinations. Our qualitative study explores obese women's barriers to Pap smears and mammograms in greater depth than previous research. We also seek to understand why some obese women undergo screening whereas others do not. A purposive sample of moderately to severely obese women over age 40 was recruited from community-based organizations, health clinics, and retail establishments. Semi-structured in-depth interviews (N = 33) informed by the Theory of Care-Seeking Behavior and three prior focus groups of obese women (N = 18) were recorded and transcribed. Qualitative analysis was iterative, using a grounded theory approach involving a series of immersion/crystallization cycles. Participants verified many barriers to cervical and breast cancer screening previously identified in the general population, including fear, modesty, competing demands, and low perceived risk. Participants also highlighted several weight-related barriers, including insensitive comments about weight and equipment and gowns that could not accommodate them. Comparison of participants who were up-to-date with both Pap smears and mammograms with those not up-to-date with either screening showed no discernable differences in these barriers, however. Instead, we found that the participants who followed through on their cancer screenings may share certain personality traits, such as conscientiousness or self-regulatory ability, that allow them to complete difficult or feared tasks. Our research therefore suggests that personality may act as an important mediator in health behavior, and should be taken into account in future theoretical models and health behavior interventions, particularly for obese women.

Factors related to the Performance of Mammography Screening among Women with a Family History of Breast Cancer in Korea

PURPOSE

Early diagnosis is the primary method aimed at controlling breast cancer. The purpose of this study was to analyze some factors affecting the performance of mammography screening among women with a family history of breast cancer in Korea.

METHODS

This study applied a descriptive design method through structured self-report questionnaires. The Care Seeking Behavior Theory provided a theoretical framework for the study. Factors measured in this study represent demographic, clinical, and psychosocial variables including anxiety, barriers, utility, habits, perception, and facilitators. A total of 212 participants, of at least 20 years old, were sampled from April 8, 2010 to March 31, 2011. The data was analyzed by logistic regression method using the Statistical Package for the Social Science 18.0 software.

RESULTS

Of the 212 participants, 122 women (57.5%) went through mammography screening. The results of the analysis showed that (a) age (Odds Ratio [OR]=1.10, p<.001), (b) facilitating influences (OR=1.83, p=.008), (c) perception of mammography importance (OR=1.92, p=.011), (d) barriers to mammography (OR=0.60, p=.031), and (e) utility of mammography (OR=2.01, p=.050) significantly affect mammography screening.

CONCLUSION

The results underscore the impact that psychosocial variables in obtaining mammography have on adherence to screening. Women with a family history of breast cancer should be given accurate information and recommendation about mammography by healthcare provider and a regular source of healthcare.

Jordanian and Palestinian immigrant women's knowledge, affect, cultural attitudes, health habits, and participation in breast cancer screening

Our purpose in this report is to describe relationships among knowledge, affect, attitudes, including cultural beliefs, about breast cancer screening (BCS), and health habits to BCS participation in a convenience sample of 130 immigrant women with Jordanian or Palestinian background living in the Washington DC area. Using our analysis of questionnaires we show correlations among knowledge, affect, utility, general health habits, and participation in BCS consistent with previous research in non-Arab samples. Measures of the relationship of cultural factors to BCS participation need refinement. Future research related to BCS among Jordanian and Palestinian women can build on the results of this study.

Examining the theory of planned behavior and the construct of self-efficacy to predict mammography intention

This article examines the applicability of the Theory of Planned Behavior (TPB) with the addition of the self efficacy construct in the understanding of the motivation to obtain an initial screening mammogram among Cypriot women. The study sample consisted of 293 women aged 40 to 65 years, asymptomatic of breast cancer, and with no previous mammography experience. The study took place at the General Hospital of Nicosia in Cyprus. The results of the study provided support of the TPB with the addition of self-efficacy in an international setting. Self-efficacy was the strongest predictor of intention. Other predictors of intention included educational level, time of last clinical breast examination, and age. The study also provided some empirical support of the distinction between self-efficacy and perceived behavioral control. Researchers may want to include self-efficacy in addition to the TPB and other demographic characteristics in future applications to more fully explain behavioral outcomes.

Validation of scales measuring attitudes and norms related to mammography screening in women veterans

Validation of psychosocial measures for use in mammography screening research has been given inadequate attention in the literature. The authors report on the validation of 5 measures examining 4 attitudinal constructs (i.e., pros, cons, outcome expectations, and cancer worries) and 1 social influence construct (i.e., subjective norms) in a 22-item inventory. The study participants consisted of a national, randomly sampled population of women veterans (n = 2,910). After minor revision of scales, the authors found independent measures for 4 constructs: pros, cons, cancer worries, and subjective norms. The authors concluded that these scales have acceptable psychometric properties; support construct validity; and provide brief, reliable, and valid measures of attitudes toward and norms regarding mammography screening. These scales may be useful for intervention research.

Cancer Screening in Older Adults in an Era of Genomics and Longevity

OBJECTIVES

To provide an overview of cancer genomics and cancer screening in older adults with a focus on breast, prostate, and colon cancers.

DATA SOURCES

Journal articles, research articles, and web sites.

CONCLUSION

Cancer screening in older populations is often in the context of one or more co-morbid conditions, cancer survivorship, genomic information, and competing health priorities. The field of cancer screening has outgrown the tools available to enable health care providers and older adults to make informed cancer screening decisions. Research is needed to develop clinical screening tools that integrate age, cancer risk, life expectancy, and comorbidity.

IMPLICATIONS FOR NURSING PRACTICE

Health care providers are faced with opportunities and challenges in the prevention and early detection of cancer in older Americans.

Coping Style and Women's Participation in Breast and Gynecological Screening

The purpose of this project was to determine the role of coping style in women's practice of breast and gynecological screening behaviors. Women were classified into one of four coping groups based on measures of vigilance and screening distress. Data were analyzed from a subset of 85 U.S. women who participated in a larger longitudinal study designed to examine self-reported screening participation. Results indicate frequency of screening participation and importance of obtaining immediate mammography feedback differed across coping style groups. Women characterized as high in vigilance and screening distress were most at risk for nonparticipation in screening.

Do attitude toward cancer, sense of coherence and family high risk predict more psychological distress in women referred for a breast cancer examination?

OBJECTIVE

The study focuses on the connection between attitude toward cancer, sense of coherence and family history of breast cancer, on the one hand, and psychological distress on the other among women who are referred for breast cancer examination following a medical examination prompted by a complaint of "feeling something in the breast."

METHOD

A sample of 314 women referred to a breast health clinic in northern Israel completed questionnaires that measured psychological distress (Brief Symptom Inventory), personal resources (the Sense of Coherence Scale), and mindset (Attitude to Cancer Treatment Scale).

RESULTS

A weak sense of coherence and a more negative attitude toward cancer (i.e., viewing victims of cancer with pity; viewing the illness as a death sentence; harboring a fear of death from cancer) predict a high level of psychological distress while awaiting an examination. A family history of breast cancer, or a first-time examination, were not found to be predictors of greater psychological distress.

CONCLUSION

Learning cognitive behavioral coping skills, as well as access to information on cancer and treatment in order to change attitude toward cancer, are needed.

Critical Thinking, Perceived Health Status, and Participation in Health Behaviors

BACKGROUND

Critical thinking has been proposed as crucial for processing conflicting information when people make decisions about participation in health behaviors. The critical thinking of individuals about participation in health behaviors may depend on their perceived health status.

OBJECTIVES

To examine the relations between critical thinking and participation in three categories of health behaviors, and to determine whether these relations are moderated by perceived health status.

METHODS

A cross-sectional, correlational design was used to study a sample of 112 community-dwelling adults who resided in a large, urban Midwest community. The participants were women and men 18 to 90 years of age (mean, 55 +/- 20.47 years) who completed self-report, written questionnaires including the Test of Everyday Reasoning and the Health Practices Instrument.

RESULTS

According to hierarchical multiple regression analyses, the relation between critical thinking and health promotion behaviors and the relation between critical thinking and secondary prevention behaviors were moderated by perceived health status, whereas the relation between critical thinking and health protection behaviors was not.

CONCLUSIONS

The relation between critical thinking and participation in health behaviors depends on perceived health status and category of health behaviors. Researchers can explore the role of other variables (e.g., functional status and perceived susceptibility to disease) to explain why perceived health status moderates the relations between critical thinking and participation in various types of health behaviors differently.

The Impact of a Family History of Breast Cancer on Screening Practices and Attitudes in Low-Income, Rural, African American Women

BACKGROUND

Women with a family history of breast cancer are at increased risk for developing cancer and, therefore, might be expected to engage in early detection practices more actively than women without a family history. Alternatively, women with a family history may avoid thinking about cancer and have attitudes and practices that do not promote early detection.

METHODS

This study examined breast cancer attitudes and practices among African American women aged >or=50 who had not had a mammogram in the last 2 years.

RESULTS

Phone survey data from 320 female clients of low-income, rural primary care clinics (91% African American) indicated that 15% self-reported a family history of breast cancer (FH(+)). Half of the FH(+) women did not know their relative risk of developing breast cancer. Of those providing a risk estimate, 67% perceived themselves at low risk compared with other women their age. Perceived relative risk was comparable between FH(+) and FH(-) women. Further, FH(+) women did not indicate greater worry about breast cancer, nor did they have more accurate knowledge of mammography recommendations than FH(-) women. Two thirds of FH(+) women had never had a mammogram. Monthly breast self-examination did not differ between FH(+) and FH(-) women.

CONCLUSIONS

Thus, neither knowledge of a positive family history nor perceived relative risk of breast cancer was associated with either increased or decreased early detection practices among these low-income, rural, African American women who have underused mammography. Furthermore, a substantial proportion of FH(+) women had not ever participated in screening mammography. Interventions to increase mammography rates in this population of underusers are indicated.

Tailored messages, external barriers, and women's utilization of professional breast cancer screening over time

BACKGROUND

The efficacy of tailored messages on women's utilization of professional breast screening over time has not been examined often or in combination with external barriers (e.g., costs and access). The objectives of this study were to test the effects of alternative messages on mammography and clinical breast examination (CBE) utilization over time and to examine the combined effects of such messages and external barriers.

METHODS

In a randomized, controlled trial, three message conditions were compared: no message (control group), recommendations about screening, or recommendations plus tailored discussion (on beliefs, feelings, costs, and access). Messages were delivered by advanced practice nurses over the telephone. Participants were women ages 51-80 years who had not had mammography in the prior 13 months. Outcome measures were women's mammography and CBE utilization 3-6 months postintervention (short-term follow-up) and 13-16 months after short-term follow-up (long-term follow-up).

RESULTS

Both messages promoted mammography and CBE utilization at short-term follow-up. Utilization increased over time in all groups. Mammography utilization was greater for the tailored-message group compared with the recommendations-only group at long-term follow-up. Messages and external barriers had combined effects (Ps < 0.01). Among participants with high external barriers, participants in the message conditions-especially the tailored message-had the highest screening rates; among participants with low barriers, screening rates were similar across conditions.

CONCLUSIONS

Clinicians can tailor discussions on beliefs, feelings, cost, and access about screening to promote professional breast screening over time, especially with women who have not had mammograms as recommended and who have external barriers to screening.

Perceived risk of breast cancer: influence of heuristic thinking

PURPOSE

The purpose of this study was to examine the influence of heuristic reasoning on women's perceived risk for developing breast cancer, and to test for an expected bias in the direction of optimism that is predicted by recent research on human cognition.

DESCRIPTION OF STUDY

In total, 770 women recruited in community settings were surveyed regarding cancer screening behavior and their perceived risk of developing breast cancer.

RESULTS

Most women perceived their risk of breast cancer to be lower than that of other women (3:1), confirming the expected bias toward optimism, and this finding was not attributable to the personality trait of optimism. Women following mammography guidelines showed greater optimism that their risk was low. Cancer knowledge and education diminished unwarranted optimism. Women with a history of benign breast disease, with a female relative with breast cancer, or both overestimated their risk. All findings suggest that heuristic thinking is being used to estimate personal cancer risk.

CLINICAL IMPLICATIONS

Clinicians should expect women to be optimistic about their personal risk of developing breast cancer. As a result, women may put off breast cancer screening or delay the evaluation of breast symptoms that may signal breast cancer. Helping women to understand their relative risk is an essential part of a health promotion visit.

Utility of health belief model as a guide for explaining or predicting breast cancer screening behaviours

AIM

The purpose of this study was to assess the utility of HBM as a theoretical guide for predicting breast cancer screening and therefore for guiding intervention studies.

BACKGROUND

Breast cancer is the leading cause of death for middle age women (35-50) and the second leading cause of cancer deaths in all women in the United States (US). Early detection of breast cancer through screening is the only option available to women. However, less than half of all women in the US participate in screening. The health belief model (HBM), which specifies interactions of values and beliefs about health and their influence on choices, has been widely used to explain screening behaviour.

METHODS

An integrative research review analysed 16 published descriptive studies employing HBM. Literature was located through a search of research based studies listed in Cumulative Index of Nursing and Allied Health (CINAHL), Medline, and cancer literature databases and studies cited in other references between 1990 and 1999.

FINDINGS

Application of HBM was inconsistent. No study tested nonlinear relationships between variables as specified in the model. At best, the model explained 47% of the variance in screening behaviour when socioeconomic status was included. Otherwise predictive power was low, ranging from 15 to 27%.

CONCLUSIONS

While the model provides some description of the values, beliefs and behaviours of middle-aged women primarily, HBM does not appear to have the power to consistently predict behaviours. Further research is needed to provide more thorough depiction of the social, nonhealth care meaning of breast cancer.

Family history of breast cancer. Impact on the disease experience

PURPOSE

Family history is the most prominent risk factor, besides advanced age, for the incidence of breast cancer among women. This study investigates differences in the experiences of women in the detection, diagnosis, and treatment of early-stage disease. The purpose of this research is to obtain a more comprehensive understanding of the impact of family history on the overall illness experience.

DESCRIPTION OF STUDY

Self-report retrospective data obtained from in-depth interviews with a convenience sample of 179 women who had recently received a diagnosis of nonrecurrent stage 0 to IIIA breast cancer are used to compare the experiences of women with and without a family history of breast cancer (FHOBC). The authors examine differences in screening behavior, method of detection, diagnostic processes, treatment decision making, and therapy receipt, and they report the results of bivariate analyses.

RESULTS

The results suggest that women with FHOBC have a different disease experience than those without an affected relative. Women with FHOBC were more likely than their counterparts to comply with screening guidelines, to seek more timely care, to consult with specialists, to be influenced by the experiences of others, to feel comfortable with treatment decisions, and to receive adjuvant therapy.

CLINICAL IMPLICATIONS

Healthcare providers should be aware that compliance with mammography and therapy guidelines may vary with FHOBC. Because the better health-related behavior reported by women with affected relatives suggests that they may have higher perceived risk, physicians should be sensitive to potentially elevated levels of anxiety, provide accurate information about relative risk, put patient concerns in the proper perspective, and include family members in treatment discussions. Alternatively, women without an FHOBC appear to have less favorable screening, detection, diagnosis, and treatment decision-making behavior. Because family doctors play an important role in the care of these patients, they may need to provide special education and counseling regarding the importance of adherence to screening guidelines, recognition of relevant symptoms, initiation of timely examinations, consultation with cancer specialists, and compliance with treatment recommendations.

Explaining women's intentions and use of hormones with menopause

The purposes of this theoretically-based study were (a) to examine the contributions of psychosocial variables (i.e., affect, beliefs, and norms), habit, and facilitating conditions to explaining women's intentions and use of hormones with menopause and (b) to assess whether clinical or demographic factors explained intentions and use, when controlling for psychosocial, habit, and facilitating conditions variables. In a cross-sectional design, 184 pre-, peri-, and postmenopausal women completed questionnaire measures. To explain intentions, data from 124 participants who were not using hormones were analyzed. To explain use, data from 125 peri- and postmenopausal participants were analyzed. In multivariate analyses, anxiety was associated inversely with use; norms were associated positively with intentions and use. Age was associated inversely with intentions; hot flashes were associated inversely with use. Future researchers can examine the combined influences of affect, beliefs, and norms on decisions about hormones. Clinicians can address anxieties and assess social influences about hormone use, as well as offer ways to deal with hot flashes.

Psychological and social determinants of women's decisions to undergo genetic counseling and testing for breast cancer

This study examined the demand for breast cancer genetic testing and counseling among Canadian women diagnosed with breast cancer under the age of 50, together with some of the factors predicting both their intentions to be tested and the degree to which they act on their intentions. Participants were 110 women under the age of 50 and comprised of two groups: 1) women diagnosed with breast cancer (BC, n = 60): and 2) an index group of unaffected women from the general population (GP, n = 50). All participants completed a survey that addressed family history of breast and other cancers, demographic variables, knowledge and attitudes about breast cancer, and genetic testing. Members of the BC group were offered genetic counseling and testing for BRCA1 and BRCA2 free of charge. Overall, 60% of participants indicated they would like the test, and 40% either did not want it or were uncertain. Seventy-two percent of women in the BC group wanted to be tested. Of these, only 49% had actually contacted the genetic counselor about testing at follow-up 3-15 months later. Intention to be tested was associated with presence of breast cancer, greater perceived benefits of testing, fewer perceived 'costs' of testing, and higher levels of concern about the risk of relatives developing breast cancer. Actual arranging to meet with the genetic counselor among women in the BC group was associated with fewer perceived costs of having the test. Results suggest a moderate level of interest in gene testing, though intention to be tested may not translate into actual uptake. Women who do choose to have the test may believe the potential 'costs' of using this new genetic technology to be relatively few. This has implications for genetic counselors in terms of providing balanced and complete information to women considering genetic testing for breast cancer susceptibility.