Health beliefs, locus of control, emotional control and women's cancer screening behaviour

Role of health locus of control in preventing occupational decompression sickness among deep-sea fisherman divers

Background

Indigenous fisherman divers frequently experience decompression sickness (DCS). This study aimed to evaluate the associations between the level of knowledge of safe diving, beliefs in the health locus of control (HLC), and regular diving practices with DCS among the indigenous fisherman divers on Lipe island. The correlations among the level of beliefs in HLC, knowledge of safe diving and regular diving practices were evaluated also.

Method

We enrolled the fisherman divers on Lipe island and collected their demographics, health indices, levels of knowledge of safe diving, beliefs in external and internal HLC (EHLC and IHLC), and regular diving practices to evaluate the associations with the occurrence of DCS by logistic regression analysis. Pearson's correlation was used to test the correlations among the level of beliefs in IHLC and EHLC, knowledge of safe diving, and regular diving practices.

Results

Fifty-eight male fisherman divers whose mean age was 40.39 (±10.61) (range 21-57) years were enrolled. Twenty-six (44.8%) participants had experienced DCS. Body mass index (BMI), alcohol consumption, diving depth, duration of time in the sea/dive, level of beliefs in HLC and regular diving practices were significantly associated with DCS (p < 0.05). Level of belief in IHLC had a significantly strong reverse correlation with that in EHLC and a moderate correlation with level of knowledge of safe diving and regular diving practices. By contrast, level of belief in EHLC had a significantly moderate reverse correlation with level of knowledge of safe diving and regular diving practices (p < 0.001).

Conclusions

Encouraging the fisherman divers' belief in IHLC could be beneficial for their occupational safety.

When Does Safety Climate Help? A Multilevel Study of COVID-19 Risky Decision Making and Safety Performance in the Context of Business Reopening

Businesses are gradually reopening as lockdown measures for the coronavirus disease 2019 (COVID-19) pandemic are being relieved in many places across the globe. It is challenging but imperative for businesses to manage the risk of infection in the workplace and reopen safely. Drawing on risky decision-making theory and the job demands-resource model of workplace safety, we examined the influences of employees' COVID-19 risk perception on their safety performance at work. On the one hand, COVID-19 risk perception motivates employees to perform safely; on the other hand, COVID-19 risk perception could also undermine safety performance through triggering anxiety. In an effort to find ways that alleviate the negative implications of risk perception, we also tested a cross-level interaction model where the risk perception-anxiety relation is weakened with a favorable team safety climate as well as low abusive supervision. Our data were collected from car dealership employees located in China in March 2020, when businesses just started to reopen in locations where these data were collected. Results showed that COVID-19 risk perception was positively related to anxiety, which in turn undermined safety performance. This negative effect canceled out the direct positive effects of COVID-19 risk perception on safety performance. In addition, cross-level interaction results showed that the buffering effect of team safety climate on the risk perception-anxiety relation was diminished with an abusive supervisor. Our findings provide valuable and timely implications on risk management and workplace safety during a public health crisis such as the COVID-19 pandemic.

Understanding the Relationship Between Sexual Assault and Cervical Screening Uptake

Abstract. Background: Cervical screening helps prevent cervical cancer ( NHS, 2019 ). Women who have experienced sexual assault have lower cervical screening attendance, however, no theory-driven research explores reasons for this. The Health Action Process Approach (HAPA) explains intention and ongoing attendance to health-promoting behaviors. Aims: The HAPA was used to identify and explore how sexual assault impacts cervical screening uptake. Method: An online study of 247 women aged 21–63 explored whether HAPA variables (task, maintenance, and recovery self-efficacy, outcome expectancies, risk perception, action, and coping planning), trauma variables (nature and age of abuse, and level of post-traumatic stress disorder symptoms [PTSD]), and other potentially confounding factors related to cervical screening uptake in women who have experienced sexual assault. Regression and mediation analyses were conducted to explore predictive variables of intention and attendance. Results: Self-efficacy beliefs predicted both intention and attendance of cervical screening. Task self-efficacy predicted intention and mediated relationships between HAPA variables and intention. Maintenance self-efficacy predicted attendance and mediated relationships between HAPA variables and attendance. Trauma variables did not predict more variance in intention or attendance over HAPA variables. Limitations: The cross-sectional nature of the study means causality was not established. Conclusion: Self-efficacy develops an understanding of cervical screening in women with experience of sexual assault, over and above the trauma variables of type of assault and PTSD symptoms. Focusing on self-efficacy to improve cervical screening uptake in women who have experienced sexual assault is considered for clinical implications.

A Model-Based Meta-Analysis of Willingness to Participate in Cancer Screening

Although early screening tests are beneficial for the detection and treatment of cancers, many people have failed to participate in screening tests. The present study aims to explore the theoretical underpinning of low participation in screening programs using the method of meta-analytic structural equation modeling. It was found that the health belief model is the most adopted theoretical framework. Moreover, the intended uptake of screening was positively predicted only by cues to action, health literacy, and perceived susceptibility. As a result, a health intention model, including the three significant variables, is proposed. The practical implications of the findings are that health communication campaigns should focus on enlightening and engaging the public through all necessary means to raise awareness and transfer knowledge in relation to screening procedures as well as cancers per se.

Relationship of Health Locus of Control with Breast Cancer Screening Belief of Iranian Women

Promoting breast cancer screening (BCS) behavior of women can lead to a reduction in mortality. The health locus of control affects cancer screening behavior of women; however, there is not sufficient evidence regaring this issue in Iran. The overall goal of our study is to determine the relationship of the health locus of control with the breast cancer screening belief of Iranian Women. This is a cross-sectional study carried out on 325 women in Tehran. The Multidimensional Health Locus of Control (MHLC), Breast Cancer Screening Belief Questionnaire (BCSBQ), and Demographic questionnaire were used for collecting data. Statistical analyze was performed by the SPSS version 17 software. The Pearson correlation and regression model were used for data analyze. In this study, 325 women, age 18 to 75 years, participated in this study. The mean±SD of BCSBQ and MHLC score was 40.72±10.41 and 67.78±17.67 respectively. The regression analysis showed that for the one-unit increase in the Internal Health Locus of Control (IHLC), Powerful others Health Locus of Control (PHLC), and Chance Health Locus of Control (CHLC) score (dimensions of Health Locus of Control), the total BCSBQ scores increased 0.54, 0.31, and 0.57 respectively. For each unit increase in age and education, the knowledge and perceptions of the BC score increased 0.05 and 0.23 units respectively. For the one-unit increase in the IHLC, PHLC, age, and education dimensions, the attitudes towards the general health check-up score increased 0.17, 0.1, 0.05, and 0.188 respectively. The current study provided new insights about the BCSB of Iranian women with MHLC. In the study, all the dimensions of the health locus of control were useful in predicting the breast cancer screening belief of the participants.

Low perceived control over health is associated with lower treatment uptake in a high mortality population of Bolivian forager-farmers

Indigenous people worldwide suffer from higher rates of morbidity and mortality than neighboring populations. In addition to having limited access to public health infrastructure, indigenous people may also have priorities and health perceptions that deter them from seeking adequate modern healthcare. Here we propose that living in a harsh and unpredictable environment reduces motivation to pursue deliberate, costly action to improve health outcomes. We assess whether variation in Health Locus of Control (HLC), a psychological construct designed to capture self-efficacy with respect to health, explains variation in treatment uptake behavior among Tsimane Amerindians (N = 690; age range: 40-89 years; 55.8% female; data collection: 2008-2012), a high mortality and morbidity indigenous population in the Bolivian Amazon, Beni Department. Comparisons with two industrialized populations in Japan (Miyagi prefecture; e0 = 76.6 years) and the United Kingdom (Caerphilly county borough; e0 = 81.2 years) confirm that Tsimane (e0 = 54.1 years) have a more externalized HLC. Multilevel level models were used to investigate whether HLC predicts treatment uptake, and mediates the relationship between modernization and treatment uptake. External HLC scores were predictive of treatment outcomes: Powerful others scores were positively associated with probability of receiving modern treatment (adjusted odds ratio [OR] = 1.33), while Chance scores were negatively associated with probability of receiving modern treatment (adjusted OR = 0.76). We found no effects, however, of Internal HLC or educational capital on treatment uptake. Overall, our findings indicate that health-related decision-making is influenced more by a psychological orientation affecting self-efficacy, shaped in part by perceptions of environmental unpredictability and harshness, than by limited knowledge, education or other indicators of modernization.

The role of self-efficacy, self-esteem and optimism for using routine health check-ups in a population-based sample. A longitudinal perspective

While several cross-sectional studies have shown that self-efficacy, self-esteem and optimism are associated with the use of routine health check-ups, little is known about this relationship based on longitudinal studies. Consequently, the purpose of this study was to examine whether these factors are associated with routine health check-ups longitudinally. Data were retrieved from a population-based longitudinal study of individuals (≥40years of age) residing in private households in Germany (two waves: 2008 and 2011). Widely established scales were used to quantify self-efficacy, self-esteem, and optimism. Respondents reported whether they used a health check-up in the last two years. Conditional fixed-effects logistic regressions were used (n=1504), adjusting for socio-demographic, lifestyle and health-related variables. After adjusting for various potential confounders, regression analysis revealed that the use of routine health check-ups increased with self-efficacy [OR: 1.71 (95%-CI: 1.14-2.55)], self-esteem [OR: 1.78 (1.16-2.73)], and optimism [OR: 1.37 (1.01-1.86)]. Furthermore, the use of routine health check-ups increased with changes from employment to retirement [OR: 2.60 (1.34-5.03)], whereas it was not associated with changes in age, marital status, smoking status, the number of physical illnesses, self-rated health and body-mass index. The current study stresses the importance of an association between screening behavior and self-efficacy, self-esteem and optimism longitudinally. Interventions aiming at modifying these psychological factors might help to increase the use of routine health check-ups.

The role of general psychosocial factors for the use of cancer screening-Findings of a population-based observational study among older adults in Germany

Within the framework of the health‐belief model, some studies exist investigating the association between illness‐specific psychosocial factors and the use of cancer screenings. However, studies investigating the association between general psychosocial factors and the use of cancer screenings are missing. Thus, this study aimed at examining the association between well‐established general psychosocial factors and the use of cancer screenings. Data were gathered from a large, population‐based sample of community‐dwelling individuals aged 40 and above in Germany (n = 7673; in 2014). Loneliness, cognitive well‐being, affective well‐being (negative and positive affect), optimism, self‐efficacy, self‐esteem, self‐regulation, perceived autonomy, perceived stress, and perceived social exclusion were used as general psychosocial factors. Furthermore, individuals were asked whether they regularly underwent early cancer screening in the past years (yes; no). A total of 65.6% of the individuals used cancer screening. Adjusting for sociodemographic factors, self‐rated health, morbidity and lifestyle factors, multiple logistic regressions revealed that the use of cancer screening is positively associated with decreased loneliness, cognitive well‐being, optimism, self‐efficacy, self‐esteem, self‐regulation, perceived autonomy, decreased perceived stress, decreased perceived social exclusion, and positive affect, while it is not associated with negative affect. This study stresses the strong association between general psychosocial factors and the use of cancer screening. This knowledge might be fruitful to address individuals at risk for underuse.

Aristotle, Hume and the goals of medicine

Whilst medicine is now an immense global industry clinicians often appear unclear as to its goals. This paper uses two philosophical steps to clarify our conceptualization of health and thus our goals for healthcare. Firstly, clinicians need to understand the significance of Hume's fact / value distinction in medicine, for medicine relies on both facts and values. Secondly clinicians need a better specified definition of 'health' to use as a goal for healthcare. Aristotle's model of human flourishing is used as the starting point for a new conceptualization of health.

Does hopelessness of Turkish women affect their behavior regarding cervical cancer prevention and early diagnosis?

BACKGROUND

The purpose of this descriptive study was to investigate attitudes women of towards cervical cancer prevention applications and early diagnosis, and whether or not their hopelessness levels had any influence.

MATERIALS AND METHODS

The present study was carried out in Isparta with a descriptive design. A sample of 251 individuals was recruited from January 2011 through May 2011 in the largest tea garden (restaurant- cafe). The data collection tool consisted of two parts: a "Questionnaire Form" identifying women; and the "Beck Hopelessness Scale". Data were analyzed using the Statistical Package for the Social Sciences (SPSS version 16.0 for Windows for the numerical and percentage distribution, average, standard deviation with the ANOVA and Mann-Whitney tests.

RESULTS

Some 70.2 % of the woman indicated that they had not taken the Pap test. There was a significant relationship between the hopelessness level and women believing that they could protect themselves from getting cervical cancer (F=10.11 p=0.00). There was a significant relationship between hopelessness levels and believing whether or not early diagnosis tests are deterministic (F=8.781 p=0.00).

CONCLUSION

Our study concluded that the hopelessness level of women had an effect on their thoughts about cervical cancer prevention and early diagnosis.

Gender Differences in Health-check Attendance and Intention in Young Adults: An Application of the Health Belief Model

Health-check attendance intention and behaviour in young men and women was compared, and the data used to determine whether health belief model constructs were able to predict such intentions and behaviour. Sixty male and sixty female respondents completed questionnaires asking about past health-check attendance behaviour, future attendance intention, and health beliefs. More females than males had previously attended a general health check, and females had stronger intentions to do so in the future. Regression analyses indicated that health-check attendance intention was predicted for both males and females by responses to cues to action. For females, previous health-check attendance was related to responses to cues to action and perceptions of barriers to attendance. None of the health belief model constructs was found to account for previous attendance behaviour of males. The results of the study support recent calls for health promotion initiatives aimed at men, but suggest that they should target cognitions other than those included within the health belief model.

A lifestyle to prevent or combat the metabolic syndrome among Japanese workers: analyses using the health belief model and the multidimensional health locus of control

We investigated the predictors significantly associated with a lifestyle to prevent or combat the metabolic syndrome among Japanese workers. We conducted an anonymous self-administered questionnaire survey and analyzed the resulting data using multiple linear regression analysis. The dependent variable was a lifestyle to prevent or combat the metabolic syndrome (7-point scale). Independent variables were: subjects' basic attributes (age, gender, blue or white collar worker, with or without a family physician), Multidimensional Health Locus of Control (7-point scale for each item), with or without the metabolic syndrome being pointed out or not by healthcare providers, and 4 items regarding the metabolic syndrome produced with reference to the Health Belief Model (7-point scale for each item). Those independent variables were all included in this model. The analysis shows the older workers, white-collar workers, and workers who had the metabolic syndrome pointed out by healthcare providers had appropriate lifestyles. Those with high scores in Powerful Others Health Locus of Control also had appropriate lifestyles. Those who realized that the metabolic syndrome was a life-threatening disease and who knew practical ways to prevent or combat the metabolic syndrome also had appropriate lifestyles. Our findings can be applied to various types of medical education regarding the metabolic syndrome.

An application of an extended health belief model to the prediction of breast self-examination among women with a family history of breast cancer

OBJECTIVES

This study reports an application of the health belief model (HBM) to the prediction of breast self-examination (BSE) among women with a family history of breast cancer. The study also considered the influence of breast cancer worries and past behaviour.

METHODS

Eight hundred and thirty-three women completed questionnaires, based on the HBM, to assess their beliefs about breast cancer and BSE. Of these women, 567 were followed-up at 9 months when BSE frequency was assessed.

RESULTS

Discriminant function analysis was employed to discriminate among infrequent, appropriate and excessive BSE. Two functions were calculated which were predictive of group membership. The first function maximally discriminated between the infrequent BSE group and the other two groups, with infrequent selfexaminers reporting a greater number of self-efficacy and emotion barriers, fewer benefits and less frequent BSE at Time 1. The second function maximally discriminated between the excessive BSE group and the appropriate BSE group, with excessive selfexaminers reporting higher levels of breast cancer worries and perceived severity and fewer self-efficacy barriers.

CONCLUSIONS

The results highlight the importance of focusing on excessive as well as infrequent BSE. Interventions designed to enhance women's confidence in their ability to perform BSE, coupled with attempts to reduce breast cancer worries, may encourage more appropriate and effective BSE.

Inconsistent mammography perceptions and practices among women at risk of breast cancer following a pediatric malignancy: a report from the Childhood Cancer Survivor Study

Women treated with chest radiation for a pediatric cancer have low mammography screening rates despite their high risk for breast cancer. This study characterized the relationship between perceptions of mammography and screening practices. A cross-sectional survey was administered to 523 women in North America who were treated with chest radiation before 21 years of age. Women with inconsistent mammography perceptions and practices were identified using the Pros and Cons of Mammography for perceptions and Transtheoretical Model stages of adoption for prior and intended screening practices. Classification and regression tree (CART) analysis was used to identify barriers to and facilitators of screening among women with positive and negative perceptions. Nearly one-third of the cohort had inconsistent perceptions and practices: 37.4% had positive perceptions and were not having mammograms; 27.6% had negative/neutral perceptions and were having mammograms. Regardless of perceptions, a recent physician's recommendation for mammography, age ≥ 40, and interest in routine health care were universally associated with mammography practices. For women with positive perceptions and a physician's recommendation, barriers to screening included high acceptance coping, low active-planning coping, and high internal health locus of control. For women with negative perceptions, acknowledging the importance of asymptomatic screening was associated with mammography.

The degree of workers' use of annual health checkup results among Japanese workers

In Japan, the Industrial Safety and Health Law obliges all workers to undergo annual health checkups in their workplaces. At the plant for this study, workers who have one or more abnormal findings pointed out in their annual health checkups are summoned by occupational health staff and subsequently attend health consultations conducted by occupational health nurses each year. We investigated what kinds of health consultations have improved the workers' use of the results of their annual health checkups by an anonymous self-administered questionnaire survey. In addition, we discussed the associations with the multidimensional health locus of control (MHLC) and the degree of the workers' use of these results. A total of 837 questionnaires were analyzed. The average age of the respondents was 47.9 yr (range: 19-68 yr). The main results suggest that it is necessary for occupational health staff to give workers practical advice to improve their lifestyle habits and convey to them the effectiveness of preventive health behaviors. Workers with high scores in the belief in the "internal health locus of control (IHLC)" and low scores in the "chance health locus of control (CHLC)" use the results of their health checkups to help them manage their own health.

Uncovering an Existential Barrier to Breast Self-exam Behavior

The present research applies an analysis derived from terror management theory to the health domain of breast examination, and in doing so uncovers previously unrecognized factors that may contribute to women's reluctance to perform breast self-examinations (BSEs). In Study 1, when concerns about mortality were primed, reminders of human beings' physical nature (i.e., creatureliness) reduced intentions to conduct BSEs compared to reminders of humans' uniqueness. In Study 2, women conducted shorter exams on a breast model (an experience found to increase death-thought accessibility) when creatureliness was primed compared to a uniqueness and no essay condition. In Study 3, after a creatureliness prime, women performed shorter BSEs when a placebo did not provide an alternative explanation for their discomfort compared to when it did. Advances for theory and breast self-exam promotion are discussed.

Survey of the degree of examinees' satisfaction with instructions on how to read results of general health checkups at a workplace

To clarify measures for making clearer instructions on how to read the results of general health checkups in a workplace by surveying the views of workers on these instructions, an anonymous self-administered questionnaire survey was conducted at a Japanese manufacturing plant. The responses of 984 male workers were analyzed. The average age of the subjects was 32.1 yr (range, 19-60 yr). Regarding the instructions, 4.1% of the subjects answered "definitely sufficient," 58.9% "somewhat sufficient," 28.0% "neither sufficient nor insufficient," 8.1% "somewhat insufficient" and 0.8% "definitely insufficient." Multiple regression analysis showed that the degree of examinees' satisfaction significantly correlated with the health condition (standard partial regression coefficient =0.189, p<0.001), knowledge of health management (standard partial regression coefficient =0.095, p=0.014), and fear of lifestyle-related diseases (standard partial regression coefficient =0.095, p=0.009). The adjusted R square value of the multiple regression analysis was 0.064. It is necessary to provide more detailed information to those with poor health. Because the instructions contain many difficult medical terms, health professionals must give instructions that are easy to understand. Those feeling fear of lifestyle-related diseases may already know how to read checkup results. It is necessary to promote awareness of lifestyle-related diseases targeting people unfamiliar with such diseases.

Masculinity and Intentions to Perform Health Behaviors: The Effectiveness of Fear Control Arguments

This study examined the impact of fear control and danger control messages on intentions to perform health behaviors. It was hypothesized that persons high in masculinity would be more influenced by messages that address fear than messages that exclusively focus on the efficacy of the behavior (danger control). To test this proposition, 172 participants were classified into high and low masculinity groups according to their scores on the Bem Sex Role Inventory, and randomly assigned fear reducing or danger control messages either encouraging detection behavior (skin cancer self-examination) or promotion behavior (sunscreen usage). Highly masculine participants demonstrated greater behavioral intentions and more positive attitudes about the behavior when exposed to a fear-reducing message. The results suggest that it is possible to motivate adaptive health behavior even when a person is engaging in fear control.

Patients? health beliefs and coping prior to autologous peripheral stem cell transplantation

The aim of this study was to determine the associations between health locus of control (LoC), causal attributions and coping in tumour patients prior to autologous peripheral blood stem cell transplantation. Patients completed the Questionnaire of Health Related Control Expectancies, the Questionnaire of Personal Illness Causes (QPIC), and the Freiburg Questionnaire of Coping with Illness. A total of 126 patients (45% women; 54% suffering from a multiple myeloma, 29% from non-Hodgkin lymphomas, and 17% from other malignancies) participated in the study. Cluster analysis yielded four LoC clusters: 'fatalistic external', 'powerful others', 'yeah-sayer' and 'double external'. Self-blaming QPIC items were positively correlated with depressive coping, and 'fate or destiny' attributions with religious coping (P<0.001). The highest scores were found for 'active coping' in the LoC clusters 'powerful others' and 'yeah-sayer'. External LoC and an active coping style prevail before undergoing autologous peripheral blood stem cell transplantation, whereas the depressive coping is less frequent, associated with self-blaming causal attributions. Health beliefs include causal and control attributions, which can improve or impair the patient's adjustment. A mixture between internal and external attributions seems to be most adaptive.

Cervical cancer screening--"For better or worse...": women's experience of screening

In Sweden, the population-based cervical cancer screening program has been in progress since the 1970s and is directed toward women between 23 and 60 years of age. The aim of this study was to explore women's experience of cervical screening after being diagnosed with cancer. A qualitative study inspired by Grounded Theory was used. Eleven women were interviewed. The interviews were analyzed using the constant comparative method. "Screening-For Better or Worse..." was identified as the core category, around which the categories "Unawareness," "Trust," "Search for Understanding," and "Making the Invisible Visible" were integrated and on which the conceptual model was built. The experience of screening had both a positive and a negative dimension for the women stricken by cervical cancer. The women had a positive experience of screening as such and they believed in its benefits. However, many women felt deceived and, because of their unawareness, questions arose for which they searched for understanding. The women requested adequate and understandable information. Their trust remained because the contact with healthcare professionals involved in screening and in the follow-up program had been reassuring.

Mammography stages of change in middle-aged women with schizophrenia: an exploratory analysis

BACKGROUND

Health care providers and educators who seek to create health promotion programs and individualized comprehensive care plans for women with schizophrenia are hindered by the lack of data to guide their efforts.

PURPOSE

This study tested the hypothesis that women with schizophrenia adhere to mammography screening guidelines at the same rate as other same-age women. The study also investigated the validity of the Health Belief (HB) and Stages of Change (SOC) models for breast cancer screening among women with schizophrenia.

METHODS

Socio-demographic and clinical variables, as well as knowledge, attitudes, and barriers were assessed as a function of stage of change related to breast cancer screening in 46 women with schizophrenia.

RESULTS

Women with schizophrenia were statistically less likely to be adherent to the screening recommendations than those without schizophrenia. Some support was found for the validity of the HB and SOC models for breast cancer screening in women with schizophrenia. Women in the Precontemplation stage had significantly higher negative attitude scores compared to Contemplation and Action/Maintenance stages (59.7, 45.7, and 43.2, respectively), and there was a trend for more barriers in the Precontemplation group (4.6, 2.6, 2.7 respectively).

CONCLUSION

Given the small sample size, further research on the rates of breast cancer screening in women with schizophrenia is warranted. Nonetheless, these data suggest that providers who care for women with schizophrenia may need to make take additional measures to ensure that this population receives appropriate screening so as to not put them at greater risk for a late-stage diagnosis of breast cancer. Furthermore, these pilot data suggest that HB and SOC theory-based interventions may be valid for increasing mammography rates in women with schizophrenia.

Psychosocial factors associated with the adherence to a colorectal cancer screening program

BACKGROUND

Although colorectal cancer (CRC) is one of the most commonly diagnosed cancers and a major cause of cancer related mortality, very little is known about why screening adherence rates are low. First-degree relatives of CRC patients are the largest group of individuals at increased risk of CRC. Psychosocial factors related to CRC screening adherence were examined in a sample of siblings of individuals diagnosed with CRC.

METHOD

To identify psychosocial factors related with participation in cancer screening examinations, 90 siblings of CRC patients were recruited. Adherence to screening by fecal occult blood test, flexible sigmoidoscopy and colonoscopy was the relevant factor. Sociodemographic variables, health locus of control (HLOC), perceived social support, knowledge about CRC and coping strategies were independent measures.

RESULTS

Significant differences were found in age, gender, retirement status, knowledge of sibling's illness, HLOC-powerful others, coping strategies (positive thinking, blaming others, seeking social support), perceived social support types (listening, affective, material) and social support sources (friends, work colleagues and health staff). Using stepwise logistic regression, the strongest predictor of adherence was knowledge of sibling's illness.

CONCLUSIONS

The findings suggest that effective strategies to increase participation in CRC screening may include efforts to improve knowledge of sibling's illness, material social support and advice from health staff.

Sociodemographic and attitudinal correlates of cervical screening uptake in a national sample of women in Britain

Sociodemographic and attitudinal correlates of self-reported cervical screening uptake were investigated among 1307 women in the target age group who participated in two national surveys conducted in Britain in 1999. Evidence for inequalities in screening uptake was mixed. Of the socioeconomic indicators, only age of completed full-time education showed a significant effect in the multivariate analysis. The strong effects of car ownership and housing tenure in the univariate analyses were eliminated by controlling for marital status, which showed a robust association with uptake. Uptake was highest among married and separated women and lowest among single and widowed women. There was no evidence that the effects of marital status and education were mediated by the attitudinal variables. Anticipated embarrassment and attitudes to screening (e.g., "There's no point going for screening if you don't have any symptoms") were significant independent predictors of uptake. These findings suggest that information campaigns need to address feelings of embarrassment and lack of understanding of the rationale for screening and that efforts should be made to encourage single and widowed women to attend.

Barriers to effective uptake of cancer screening among black and minority ethnic groups

AIM

To describe some of the factors that act as barriers to effective uptake of breast and cervical cancer screening services among black minority ethnic (BME) groups living in Brent and Harrow in the UK.

DESIGN

A series of focus groups among African Caribbean, African, Gujarati, Pakistani, Greek and Arabic groups were held to discover their perceptions of cancer screening, the barriers to effective uptake and some strategies for intervention.

SAMPLE

This consisted of 135 participants: 85 women and 50 men.

RESULTS

Analysis of focus group data has revealed poor knowledge, underlying health and cultural beliefs, attitudes, language and unhelpful attitudes of health professionals to be important barriers. In terms of strategies for effective intervention, the most popular strategy for improving uptake of screening services was community-based cancer awareness education that is sensitive to religious and cultural needs.

CONCLUSION

There is a need to provide community-based education to increase the uptake of screening services among BME groups. It is essential to plan concurrently to educate GPs and other health professionals in cultural beliefs and customs, language needs, racial awareness and communication skills.

The Effects of Perceived Stress on Reactions to Messages Designed to Increase Health Behaviors

This study examined the impact of perceived stress on responses to messages that encouraged the performance of health promotion and disease detection behaviors. It was hypothesized that increases in perceived stress would be associated with decreased processing of messages encouraging disease detection behaviors, and that increases in perceived stress would not effect the processing of messages encouraging health promotion behaviors. To test these hypotheses participants completed a perceived stress measure and then read a message that encouraged the performance of either a health promotion or a disease detection behavior. Then the participants were asked to indicate their agreement with the message and to attempt to recall the message. The results indicated that participants experiencing higher levels of perceived stress spent less time reading and recalled less of the messages about detection behaviors than of the messages about promotion behaviors. When participants were experiencing lower levels of perceived stress these differences disappeared.

Breast self-examination practices among women from six ethnic groups and the influence of cancer worry

Diverse samples of women (N = 1364) from Brooklyn, New York, were interviewed regarding their breast cancer screening practices. Of interest here is the relation between cancer worry and adherence to breast self-examination (BSE) guidelines among the six ethnic groups identified--European American, African American, Haitian, Dominican and English-speaking Caribbean women. There was a significant difference in cancer worry by ethnicity. Logistic regression analysis indicated that education, cancer worry, and perceived efficacy of BSE significantly predicted adherence. Furthermore, there were significant differences among women of African descent in BSE adherence and cancer worry. These differences reflect the emerging need for researchers to empirically and methodically investigate ethnic and cultural factors, as well as emotions and affect in preventive health behaviors.

“Like roulette”: Australian women's explanations of gynecological cancers

Drawing on data from interviews and other ethnographic research, we examine how Australian women from different ethnic and cultural backgrounds make sense of having gynecological cancer. Alternative explanatory models often co-exist in a single narrative, but there is significant consistency in the etiology of cancer among Australian-born and immigrant women. In acknowledging the unpredictability of cancer and the prognosis of particular disease, women contextualize their own experience as a matter of luck, outside their control or influence. Most often women relate their own occurrence of cancer to their social setting and relational factors rather than personal behavior, but at the same time, they acknowledge the interaction of external forces and individual factors, particularly in the case of diet and stress. Women can control diet to some extent, although many note the irony of having developed cancer even when they have eaten well. Stress, on the other hand, is largely considered as external to and beyond women's control. Women speak of stress as a characteristic of contemporary social life, as well as their own public and domestic, physical and emotional lives; for these women stress in any of these areas can create physical vulnerability that may result in cancer. Since women associate cancer with loss of control, the idea of cancerous cells out-of-control within their bodies operates as a metonym of women's views of themselves interpersonally and socially.

Teams in organizations: from input-process-output models to IMOI models

This review examines research and theory relevant to work groups and teams typically embedded in organizations and existing over time, although many studies reviewed were conducted in other settings, including the laboratory. Research was organized around a two-dimensional system based on time and the nature of explanatory mechanisms that mediated between team inputs and outcomes. These mechanisms were affective, behavioral, cognitive, or some combination of the three. Recent theoretical and methodological work is discussed that has advanced our understanding of teams as complex, multilevel systems that function over time, tasks, and contexts. The state of both the empirical and theoretical work is compared as to its impact on present knowledge and future directions.

Psychological costs of inadequate cervical smear test results

The purpose of the study is to investigate, for the first time, the psychological impact of an inadequate smear test result. A prospective questionnaire design was used, and the setting was a single English cervical screening laboratory. Two groups of women receiving either a normal test result (n=226) or either a first or nonconsecutive inadequate smear test result (n=180) participated. The main outcome measures included State anxiety (STAI) and concern about test result, assessed within 4 weeks of receipt of results, and attendance for a repeat cervical smear within 3 months. Compared to women with normal test results, women with inadequate smear test results had higher state anxiety (P=0.025), were more concerned about their results (P<0.001), perceived themselves to be at higher risk of cervical cancer (P=0.016), and felt less satisfied with the information they had received about their test results (P<0.001). The only predictor of attendance for a repeat smear test following an inadequate smear test result was state anxiety (P=0.011): nonattenders had higher levels of state anxiety in response to their initial test results. In conclusion, in this first study to assess the psychological impact of receiving an inadequate smear test result, we have shown that it raises state anxiety and concern to levels similar to those found in women with abnormal smear test results. Of particular concern is that anxious women are less likely to attend for a repeat smear test within the recommended time frame. Given the millions of women each year receiving this test result, research is now needed to ascertain how the anxiety associated with this result can be avoided.

Cancer prevention among rural youth: building a "bridge" to better health with genealogy

BACKGROUND

The Bridge to Better Health (BRIDGE) project is a program that focuses on providing rural high school youth with motivation, knowledge, and skills essential to cancer prevention. In this pilot intervention, we used instruction in personal health genealogy as a means of increasing awareness and knowledge of health risk and motivation to change several screening and cancer-related behaviors.

METHODS

We administered a Bridge to Better Health survey to 173 ninth- and 10th-grade students from a rural Southeastern Virginia high school before and after delivery of the BRIDGE pilot intervention.

RESULTS

Significant preintervention to postintervention changes were observed for general genealogy knowledge, personal health genealogy, self-efficacy, and intention to practice self-examinations (breast, testicular, and skin) and eating a high-fiber and low-fat diet.

CONCLUSION

These project results demonstrate the importance of theory-driven interventions for increasing cancer knowledge and changing cancer-related dietary and screening behaviors.

Increasing mammography screening among women over age 50 with a videotape intervention

BACKGROUND

A randomized trial was conducted to test the effectiveness of a videotape for increasing mammography screening among a multiethnic sample of older women.

METHODS

A multiethnic sample of Caucasian, African-American, and Hispanic women between the ages of 50 and 70 was recruited from Resident Lists compiled by the State of Massachusetts. After completing a baseline questionnaire, women were randomized to receive either a videotape or pamphlet about mammography and recontacted at 2 and 12 months after baseline to assess attitudes, beliefs, and mammography screening. A total of 581 women completed questionnaires at all three time points.

RESULTS

At baseline, approximately 75% of women reported having a mammogram in the past year and 90% reported having one in the past 2 years. Rates did not differ between groups. At the 12-month follow-up, mammography rates, adjusted for baseline screening, were 80.4% in the video and 74.8% in the pamphlet group. Logistic regression analysis of mammography at 12 months (within past year vs. >1 year ago) controlling for baseline mammogram produced an odds ratio of 1.48 for the video group that was not significantly different from unity (95% CI = 0.95-2.28).

CONCLUSIONS

The videotape had a small effect on increasing mammography screening. Although the effect was smaller than more intensive interventions, the video is a convenient, low cost, and easily implemented method to increase mammography screening.

Impact of benign breast biopsy upon breast self-examination

Current American Cancer Society guidelines recommend monthly performance of breast self-examination (BSE) for women over 20 years of age. While the experience of a benign breast biopsy can result in elevated levels of distress, the impact of benign biopsy upon breast cancer (BC) screening behavior is not well known. The present study examined frequency of BSE practice in 102 women after benign breast biopsy (biopsy group). Telephone interviews were completed a mean of 21 days (initial interview) and 8 months after biopsy (follow-up interview). A healthy comparison (HC) group of women (n = 76) without a history of breast biopsy completed an initial interview only. Information regarding distress, dispositional characteristics, BC screening-related attitudes and behaviors, and subjective and objective risk for BC was collected. Results indicated that the biopsy and HC groups did not differ in typical (i.e., prebiopsy) practice of BSE. However, practice of BSE changed after biopsy with a general trend toward a decrease in BSE frequency. Only 8% of women in the biopsy group reported appropriate (once per month) practice of BSE at the 8-month Follow-up while 28% reported appropriate practice at the initial interview. Decreases in BSE performance after biopsy were characteristic of younger women, women who lacked confidence in the ability to perform BSE correctly, and women whose biopsy was preceded by discovery of a breast lump or abnormality during BSE. Results suggest the potential value of a psychoeducational intervention after biopsy to enhance appropriate performance of BSE.

A Large Population-Based Randomized Controlled Trial to Increase Attendance at Screening for Cervical Cancer

Objective: Although cervical cancer is one of the potentially most preventable malignancies, it is still fairly common. In settings with established screening programs, increased compliance is important for future reduction in cervical cancer incidence, but it is presently unclear how this can be effectively achieved. Methods: We conducted a randomized controlled trial including all 12,240 women invited to organized screening in Sweden. To increase compliance, three successive interventions were tested: (a) modified invitation versus the standard invitation letter, (b) reminder letter to nonattenders after the first intervention versus no reminder letter, and (c) phone reminder to nonattenders after the reminder letter versus no phone reminder. We analyzed the proportion of women attending screening after each intervention and the cumulative proportion after the interventions as well as the cumulative proportions of cytologic abnormalities. Results: The modified invitation did not increase attendance compared with the standard invitation letter [difference 1.3% 95% confidence interval (CI) −0.3 to 2.9]. In contrast, a reminder letter increased the proportion of women attending with 9.2% (95% CI 7.9–10.5) compared with women who did not receive a reminder letter, and a phone reminder increased the proportion of women attending with 31.4% (95% CI 26.9–35.9). Combinations of modified invitation, written reminder, and phone reminder almost doubled attendance within 12 months, and the number of detected cytologic abnormalities was more than tripled. Conclusion: Simple reminders by mail and phone can drastically increase women's participation in Papanicolaou smear screening and increase the number of detected precursor lesions and thereby save lives.

Relationship between the intention to repeat a papanicolaou smear test and affective response to a previous test among Korean women

The purposes of this descriptive cross-sectional study were to describe (1). women's affective (emotional) responses before, during, and after a Papanicolaou smear test and after receiving the test result and (2.) the difference in affective response between women who did or did not intend to repeat the Papanicolaou smear test in the future. The theory of reasoned action was used as the theoretical basis for this study. Participants were selected by convenience sampling and included 515 women aged 24 to 69 years who had a previous Papanicolaou smear test, did not have cervical cancer, and who agreed to participate. Affective response was measured with an instrument developed by Park. Intention to repeat the Papanicolaou smear test was measured with a single question on intention of repeating the Papanicolaou smear test. Women with intention to repeat the Papanicolaou smear test showed higher apprehension after the test ( = 2.695, =.04) and higher positive affective responses such as feeling relieved, great, and comfortable after receiving the test result ( = 3.014, =.003). This result suggests that women with the intention to repeat the test are more concerned with the test result and that emotional relief after confirming normal findings is an important motivator for repeating the Papanicolaou smear test.

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.

Concepts of illness causation and attitudes to health care among older people in the Republic of Ireland

Fifty-one older people (26 of them women) in the Republic of Ireland were interviewed using a semi-structured schedule on their health and illness experiences at three different time points in their lives; as children, as young adults and presently. Of particular interest were their views about the causes of heart disease, cancer and tuberculosis and their experiences of the prevailing health care system during their lifetime. Participants were recruited by letter from a database of respondents to a previous national quantitative survey of older people. Of 247 people originally contacted 127 (51%) responded by letter and 51 of these took part in the interview study. Data were analysed according to principles of content analysis using NUDIST software. Reported ideas about causes of illnesses were multicausal. These were categorised as behavioural, biological, psychosocial or other explanations. While respondents placed most emphasis on behavioural explanations, this was accompanied by more complex views and critical questioning of formal health education messages. There was a strong allegiance to current biomedical concepts and practices. This appeared to be explained in part by reported negative experiences of health care treatments during childhood, particularly in hospitals, now perceived to be much improved. Advances in biomedicine were discussed with accounts of benefits received or observed by participants. An analysis of the history of health services in Ireland suggests that some of the attitudes reported reflect the experiences of the respondents as a generation rather than as older people per se and hence highlights the impact of public policy on people's experiences of and attitudes toward health and health care systems.

Work-group characteristics and performance in collectivistic and individualistic cultures

The authors conducted a cross-cultural longitudinal investigation of the effects of culture (individualism-collectivism dichotomy) on group characteristics (functional heterogeneity, preference for teamwork, group potency, outcome expectation) and on performance of 83 work groups performing 2 decision-making tasks over a 15-week period. The individualists (U.S. students) reported higher levels of functional heterogeneity and group potency and attained higher levels of group performance than did the collectivists (Korean students). In addition, culture and time interacted to influence ratings of group potency and outcome expectation. The difference in ratings of group potency between individualists and collectivists increased over time. Outcome expectation was greater among the collectivists in Time 1 and among the individualists in Time 2. The authors discuss implications for future cross-cultural group research and international management.