与乳腺癌筛查和寻求帮助行为相关的健康和健康信念因素：欧洲证据的系统评价和荟萃分析。

Health and health belief factors associated with screening and help-seeking behaviours for breast cancer: A systematic review and meta-analysis of the European evidence.

机构信息

Coventry University, UK.

P. M. Kato Consulting, Mountain View, California, USA.

出版信息

Br J Health Psychol. 2020 Feb;25(1):107-128. doi: 10.1111/bjhp.12397. Epub 2019 Dec 26.

DOI:10.1111/bjhp.12397

PMID:31876992

Abstract

PURPOSE

The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe.

METHODS

Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis, a narrative synthesis was undertaken.

RESULTS

Sixty-five studies were included. Never having had cervical screening (d = -.72, p < .001) and higher perceived barriers to mammography (d = -.40, p < .001) were associated with lower levels of screening attendance. Possessing health insurance (d = .49, p < .001), greater perceived benefits (d = .31, p < .001) and motivation (d = .36, p = .003) towards screening, and higher perceived seriousness (d = .24, p = .019) and susceptibility (d = .20, p = .024) towards breast cancer were associated with a higher level of screening attendance. Presenting with a non-lump symptom was associated with a longer time to presentation (d = .32, p < .001). The narrative synthesis revealed that previous benign breast disease was associated with a higher level of screening attendance but with a longer time to presentation.

CONCLUSIONS

The review identified key similarities in factors associated with screening and help-seeking behaviours which offer scope for combined interventions aimed at women that target both behaviours. Furthermore, the review highlighted that fewer studies have focused on help-seeking behaviour, despite two thirds of breast cancer cases being self-detected. Future research should further examine predictors of help-seeking behaviour including a focus on modifiable factors, such as BMI, and physical activity.

摘要

目的

本系统评价旨在确定与欧洲女性接受乳房 X 光检查或因乳腺癌症状自行寻求医疗帮助相关的健康或健康信念因素。

方法

在 2005 年至 2018 年期间，对五个数据库中的文章进行了搜索。对与筛查参与相关的 13 个因素和与寻求帮助行为相关的两个因素进行了荟萃分析。如果纳入荟萃分析的研究数量太少，则进行叙述性综合。

结果

共纳入 65 项研究。从未接受过宫颈癌筛查（d=-.72，p<.001）和更高的乳房 X 光检查障碍感（d=-.40，p<.001）与较低的筛查参与水平相关。拥有健康保险（d=0.49，p<.001）、更高的感知益处（d=0.31，p<.001）和对筛查的动机（d=0.36，p=0.003），以及更高的感知严重性（d=0.24，p=0.019）和对乳腺癌的易感性（d=0.20，p=0.024）与更高的筛查参与水平相关。出现非肿块症状与就诊时间延长相关（d=0.32，p<.001）。叙述性综合揭示了与筛查和寻求帮助行为相关的关键因素存在相似性，这为针对女性的同时针对两种行为的联合干预措施提供了机会。此外，该综述强调，尽管三分之二的乳腺癌病例是自我发现的，但关注寻求帮助行为的研究较少。未来的研究应进一步研究帮助寻求行为的预测因素，包括关注可改变的因素，如 BMI 和身体活动。