Instrument development for health belief model constructs

Research was conducted to develop valid and reliable scales to test the Health Belief Model (HBM). The dependent variable chosen for scale development was frequency of breast self-examination. Independent variables were constructs related to the HBM: susceptibility, seriousness, benefits, barriers, and health motivation. Analyses for construct validity and theory testing included factor analysis and multiple regression. Chronbach Alpha and Pearson r were used to compute reliabilities. Scales that were judged valid and reliable were susceptibility, seriousness, benefits, barriers, and health motivation.     

Screening for cervical cancer among Israeli lesbian women

Background:  The proportion of lesbian women who contract the human papilloma virus may reach 13% or even 21%; however, lesbian women were found to receive Pap smear tests less often or less regularly.
Aim:  To explore factors influencing lesbian women to undergo Pap smear tests and to determine whether the Health Belief Model (HBM) is able to predict whether lesbian women would be willing to undergo the test.
Method:  This is a correlational quantitative study guided by the HBM. A convenience sample of 108 Israeli lesbian women was recruited from local events in the lesbian community in the city of Tel Aviv, Israel. Data were collected using a self-administered questionnaire.
Findings:  Findings indicate that only 22.2% of the women had undergone Pap smear tests in the past, but a slightly higher proportion, 30.8%, intended to be tested during the next year. Older women were found to be more compliant with the test. Model-based factors affecting actual testing were perceived benefits and barriers. Factors affecting women's intention to be tested were perceived susceptibility, perceived benefits and general health motivation.
Conclusions:  Effective strategies for nurses promoting cervical cancer screening among lesbians should address ways to improve familiarity with Pap smear tests, raise physicians' awareness of offering the test to lesbians and emphasize the importance of women-based medical teams.     

Factors associated with adherence to fecal occult blood testing for colorectal cancer screening among adults in the Republic of Korea

PurposeRepeated participation in fecal occult blood testing (FOBT) is one of the major factors affecting the long-term success of population-based colorectal cancer screening programs. The aim of this study is to explore strong factors linked to repeated participation in FOBT in the prior decade (2002–2011) among adults using the Health Belief Model (HBM) after controlling for other covariates.MethodsData were obtained from South Korean adults, aged 50 years and over, who visited a national health screening center within a magnet hospital (N = 237). A pilot test was conducted to investigate the internal consistency of the HBM instruments and the clarity of survey questions. Sample characteristics and rates of adherence to FOBT screening were examined using means and frequencies. Important factors associated with adherence to FOBT were examined using multivariate logistic regression analysis.ResultsAbout 44% of the respondents were adherent to FOBT screening over the prior decade. Four out of the six HBM-driven factors (perceived susceptibility, severity, and barriers, and health motivation) were statistically significant. Those with greater levels of susceptibility and health motivation and lower levels of severity and barriers were more likely to adhere to FOBT.ConclusionsHealth professionals should focus more on the four modifiable HBM-related factors to encourage adults to adhere to FOBT. Intervention programs, which lower perceived severity and barriers and increase susceptibility and health motivation, should be developed and implemented.     

Benefits, barriers, sources of influence, and prostate cancer screening among rural men

ABSTRACT Objective: The objective of this study was to explore 3 research questions: (1) What are the perceived benefits of screening for prostate cancer (PC)? (2) What are the perceived barriers to screening for PC? and (3) Is there an association with perceived benefits or perceived barriers and participants' reported source of influence related to prostate cancer screening (PCS) decisions? Design and Sample: A nonexperimental exploratory design was used for the study. Sample included 94 rural‐dwelling male participants aged 40 and older. Measures: The instruments used included an adapted version of Champion's (1999) revised Health Belief Model scale and a researcher‐developed demographic and PCS patterns form. Results: Both benefits and barriers were significantly associated with PCS and sources of influence. Health care providers and family were highly reported, at 81.8% and 59.5%, respectively, as sources of influence regarding PCS decisions. Conclusions: In this primarily African American sample, significant barriers to PCS among rural men were indentifed. PC health education may need to include family, whom study participants highly reported as a source of influence regarding their PCS decisions.     

Factors associated with participation by Mexican migrant farmworkers in a tuberculosis screening program

BACKGROUND: Tuberculosis is an important public health concern among migrant farmworkers in the United States; providing appropriate screening and treatment is difficult due to their highly mobile existence. PURPOSE: To analyze the relationship between variables (susceptibility, severity, barriers, benefits, cues to action, normative beliefs, subjective norm, attitude, and intention) from the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA) and participation by Mexican migrant farmworkers in a tuberculosis screening program. METHOD: A convenience sample of 206 migrant farmworkers were recruited after a presentation of a tuberculosis education program and were tracked during the administration and reading of the tuberculosis skin test. Participants were interviewed in Spanish by the principal investigator using the Tuberculosis Interview Instrument (TII) developed for this study. RESULTS: Most subjects were male, aged 18-27 years, and had less than a sixth-grade education. Of the 206 subjects, 152 (73.4%) received the skin test, 149 (98%) had the skin test read, and 44 (29.5%) had positive skin tests. Based on logistic regression analysis, the model that best predicted intention included cues to action, subjective norm, susceptibility, and attitude. Participation in screening was best predicted by a model containing only two variables: intention and susceptibility. CONCLUSIONS: In this study, logistic regression analysis revealed that a more parsimonious model than the full HBM and TRA model accurately predicted both intention and behavior. The findings may be helpful in developing tuberculosis education and screening programs for Mexican migrant farmworkers.     

Attitudinal variables related to intention, frequency and proficiency of breast self-examination in women 35 and over

A correlational study was conducted to identify attitudinal variables specified by the Health Belief Model that were related to intent, frequency, and proficiency of breast self-examination. The probability sample consisted of 380 women age 35 and over who were contacted via random digit dialing. Data were collected during in-home interviews. Results supported the combined ability of susceptibility, seriousness, barriers, health motivation, and control to predict intent to practice breast self-examination (R = .61, p. less than or equal to .001). In addition, frequency and total proficiency for breast self-examination were predicted by health motivations, susceptibility, and barriers using discriminant analysis. Results lend support to use of the Health Belief Model variables in predicting women's intention and actual behavior of breast self-examination.     

Adaptation of Champion's Health Belief Model Scale for Turkish women and evaluation of the selected variables associated with breast self-examination

The purpose of this study was to adapt Champion's Revised Health Belief Model Scale for Turkish women and to examine selected sociodemographic variables associated with breast self-examination (BSE). Data were collected from a total of 430 females who were living in one of the Health Center areas located in Izmir, a city in the west of Turkey. Champion's revised Health Belief Model Scale was translated into Turkish, validated by professional judges, translated back into English, and then tested. Factor analysis yielded 7 factors: susceptibility, seriousness, barrier 1, barrier 2, confidence, benefits, and health motivation. Significant correlations were found between 2 barriers. Therefore, 2 barriers were considered one barrier subscale. All the items on each factor were from the same construct. Cronbach alpha coefficients ranged from .58 to .89, and test-retest reliability coefficients ranged from .89 to .99 for the subscales. Women who received low scores on barriers reported greater frequency of BSE practice. Likewise, women having high scores on confidence, benefits, health motivation, susceptibility, and seriousness reported a greater frequency of BSE in the last year. The frequency of BSE practice was higher in high school and university graduates, women with a family history of breast cancer, and women with breast cancer and BSE training. The Turkish version of Champion's Revised Health Belief Model Scale was found to be a valid and reliable tool for use with Turkish women. It could be used to evaluate health beliefs about breast cancer and BSE among Turkish women.     

Revisiting the Health Belief Model: nurses applying it to young families and their health promotion needs

The Health Belief Model (HBM) was reviewed with the aim of modifying it so that it reflected a health promotion stance for young families. Since this model's inception, health professionals like nurses have been involved in using the HBM to guide their practice. It is argued that to assist families, nurses now need a model that is focused on "health." In support of this approach, reorienting the HBM and basing it on "positive" health definitions associated with health promotion, by modifying it through adding the constructs "perceived behavioral control" (representing health locus of control) and "behavioral intention" from Ajzen will provide nurses with a more appropriate and useful model for interacting with families and their preschool children. A summary of positive and negative aspects of the modification of the HBM is presented, followed by a strategy for the process of validating the revised HBM for young families.     

Factors related to practice of breast self-examination in rural women

The purpose of this study was to examine variables related to breast self-examination (BSE) in rural women. The sample of convenience consisted of 347 women who were members of selected county-extension homemaker clubs. Champion's Health Belief Model Scale was used to measure susceptibility, seriousness, benefits, barriers, health motivation, sociodemographics, and knowledge variables and frequency of BSE. Multiple regression analysis indicated that the Health Belief Model concepts accounted for 26% of the variance in BSE practice. Women who perceived more benefits of BSE in reducing the severity of breast cancer were more likely to report more frequent BSE. Women who perceived fewer barriers to performing BSE and those who scored high on health motivation were also more likely to report performing monthly BSE. Pearson product-moment correlation indicated a significant positive relationship between the variables of BSE knowledge and BSE practice (r = 0.1216; p = 0.023). The lambda statistics showed weak or no association between the demographic variables of age, race, marital status, religion, education, personal experience with breast disease, and friend's experience with breast disease and BSE practice. These findings suggest that perhaps educational programs emphasizing benefits of BSE may be implemented for women represented in this sample in an attempt to increase the number of women practicing BSE. Assessment of women's perceptions of potential barriers would allow nurses to plan appropriate strategies that could reduce the barriers. Finally, assessment of women's general health practices may identify women motivated toward good health. These women may be likely to complete monthly BSE if encouraged to do so.     

Parents and caregivers of depressed adolescents: learning about experiences that led to the search for specialized care

This study is aimed at analyzing the processes and the motivations that lead parents and caregivers to notice the depressive illness in adolescents and at understanding the influence of health beliefs and cultural habits in the search of specialized treatment. Using the qualitative case study method, four parents and/or caregivers of adolescents with diagnoses of depression under treatment at a mental health clinic in the city of Campinas, State of S?o Paulo, were interviewed. In accordance with the theoretical presumptions of the Health Belief Model (HBM), the categories that were created and discussed were: the perception of parents and caregivers regarding the susceptibility to the depressive illness; the perception of parents and caregivers regarding the severity of the depressive illness; external stimuli influencing the search for specialized treatment; the barriers and benefits perceived for the search for specialized attendance; structural and social variables influencing the search for specialized attendance.     

Predictors of Papanicolaou testing in working women in Bangkok, Thailand

Cervical cancer is the leading cause of death among women in Thailand. A significant number of Thai women have never received cervical cancer screening. This study examined the perceived susceptibility, benefits, and barriers that influence Papanicolaou testing and examined the relationships between socioeconomic factors and obtaining a Papanicolaou test among women working in 1 government agency and 3 private sector companies in Bangkok, Thailand. The Health Belief Model was used to guide the cross-sectional design of the study. The Susceptibility, Benefits, and Barriers Scale was mailed to 300 working women. The response rate to the survey was 63% (N = 189). Logistic regression analysis showed that perceived barriers were significant predictors of Papanicolaou testing (beta = -.13, P < .001). Women who reported barriers were significantly less likely to obtain a Papanicolaou test (odds ratio, 0.88; P < .001). The specific barriers to engaging in Papanicolaou testing were embarrassment, fear, time constraints, knowledge deficits, and cost. Marital status, age, education, and family income were other factors related to Papanicolaou testing. Findings suggest that screening rates may be improved by addressing a combination of research, health policy, and cultural factors in these women through a nationwide campaign.     

Health beliefs, health locus of control, and women's mammography behavior

Research has shown that routine mammography screening can significantly reduce mortality from breast cancer. The use of mammography screening, however, remains well below national goals. In an effort to understand the factors that influence women's mammography behaviors, this study explored the relation between health beliefs, locus of control, and women's mammography practice. Survey instruments used were Champion's health belief scales and the Multidimensional Health Locus of Control (MHLC) scales. The study used a convenience sample of 25 African Americans and 72 white women ages 35 to 84. Findings showed that women who participated in mammography screening were significantly more likely to perceive greater benefits, greater health motivation, and fewer barriers to screening than those who did not participate. These same three variables were similarly associated with greater frequency of receiving mammograms. It also was found that perceived benefits and health motivation were significantly correlated with shorter duration of time since the last mammogram. No support was found for perceived susceptibility, perceived seriousness, and health locus of control as predictors of women's mammography behavior. Implications for nursing research in further examining the MHLC and the Health Belief Model construct of susceptibility as they relate to mammography behavior are identified. Practice implications for nurses are suggested.     

Preventive skin care beliefs of people with spinal cord injury

Although health beliefs have been correlated with self-care adherence in other chronic conditions, little is known about skin care beliefs after spinal cord injury (SCI). The purpose of this qualitative study was to identify the skin care beliefs of individuals with SCI. The conceptual framework was the Health Belief Model (HBM), which proposes that adherence to a health regimen is motivated by beliefs about susceptibility, severity, barriers, benefits, and self-efficacy. Purposive sampling was used to recruit 22 people with SCI. Content analysis of data collected using semistructured questions was used to identify domains of skin care beliefs, including HBM components. Themes that emerged about skin care beliefs included taking vigilant care, taking charge, maintaining health, and passing up care. Although most participants believed they were susceptible to pressure ulcers and preventive care was important, paradoxical statements about beliefs and preventive behaviors were common. These incongruent responses may reflect ambivalence about competing priorities or the efficacy of preventive practices. Further research is needed to understand this phenomenon. Increased understanding of skin care beliefs will assist in developing tailored teaching programs for people with SCI.     

The influence of nurses' knowledge, attitudes, and health beliefs on their safe behavior with cytotoxic drugs in Israel.

The purpose of this study was to examine the influence of the nurses' knowledge, attitudes, and health beliefs on their behavior and their actual usage of safety measures while handling cytotoxic drugs in their daily work surroundings. The Health Belief Model (HBM) and its extensive form, the Protection Motivation Theory (PMT), were used as the theoretical frameworks. Sixty-one nurses participated in the study, 31 hospital-based nurses daily exposed to cytotoxic drugs for the last 5 years, and 30 non-exposed community nurses. An occupational questionnaire was used to test the nurses' actual safe behavior and compliance with the recommended guidelines. A randomly selected group of exposed nurses were observed to validate their compliant behavior. A gap was found between the nurses' knowledge and their actual behavior concerning the potential risks of cytotoxic drugs and their use of protective measures (p < .005). Significant correlations were found among the components of the extensive HBM (perceived susceptibility, barriers, benefits and self-efficacy). The observational findings supported the above results. The study's findings support the need to promote primary prevention by providing a safe environment for the employee by means of education, training with regard to safety measures, clear policy, written guidelines and their enforcement.     

The relationship of breast self-examination to health belief model variables

The relationship between frequency of breast self-examination and Health Belief Model variables was assessed in a convenience sample of 588 women. Susceptibility, seriousness, benefits, barriers, health motivation, control, and knowledge of breast cancer and breast self-examination were measured by scales previously tested for validity and reliability. Individual items measured the frequency of breast self-examination and the method by which breast self-examination was taught. Multiple regression and discriminant analysis demonstrated that barriers, knowledge, and susceptibility were correlated with frequency of breast self-examination (R = .53, p = less than or equal to .001). In addition, persons taught by a doctor or nurse evidenced greater frequency of breast self-examination than those taught in other ways.