Stein J A, Fox S A, Murata P J, Morisky D E
Department of Psychology, University of California, Los Angeles 90024-1563.
Health Educ Q. 1992 Winter;19(4):447-62. doi: 10.1177/109019819201900409.
Regular screening mammograms for asymptomatic women are the most effective method for early detection of breast cancer. This study assessed the relative influence of Health Belief Model (HBM) constructs on prior mammography usage and the intention to obtain mammograms with data from a sample of 1,057 women over the age of 35 years residing in an urban community in the United States. Covariance structure analysis with latent variables was used initially to perform a confirmatory factor analysis of indicators of Socioeconomic Status (SES), Perceived Susceptibility, Perceived Barriers, Perceived Benefits, Cues to Action, Prior Mammography, and Future Intentions. Once a plausible factor structure was confirmed, a predictive path model was tested with Future Intentions and Prior Mammography as the outcome variables. Cues to Action, operationalized as a physician influence variable, particularly impacted Prior Mammography, and Perceived Susceptibility was the most powerful predictor of Future Intentions. SES only related significantly to Perceived Barriers, and Cues to Action, and did not directly influence Prior Mammography and Future Intentions. HBM predictor variables alone accounted for the relationship between previous mammography experience and intentions to obtain mammograms in the future. Health education implications and an applied outreach program are discussed.
对无症状女性进行定期乳房X线筛查是早期发现乳腺癌最有效的方法。本研究利用居住在美国城市社区的1057名35岁以上女性的数据，评估了健康信念模型（HBM）各构成要素对既往乳房X线检查使用情况以及进行乳房X线检查意愿的相对影响。最初使用具有潜在变量的协方差结构分析对社会经济地位（SES）、感知易感性、感知障碍、感知益处、行动线索、既往乳房X线检查和未来意愿的指标进行验证性因素分析。一旦确认了合理的因素结构，就以未来意愿和既往乳房X线检查作为结果变量对预测路径模型进行检验。作为医生影响变量实施的行动线索对既往乳房X线检查有特别显著的影响，而感知易感性是未来意愿最有力的预测因素。SES仅与感知障碍和行动线索显著相关，并未直接影响既往乳房X线检查和未来意愿。仅HBM预测变量就解释了既往乳房X线检查经历与未来进行乳房X线检查意愿之间的关系。文中讨论了健康教育的意义以及一个应用推广项目。
