Department of Public Health, Kaohsiung Medical University, 100 Shih-Chung 1st Road, San-Ming Dist, Kaohsiung, 807, Taiwan.
Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Cancer Educ. 2021 Aug;36(4):832-843. doi: 10.1007/s13187-020-01711-7.
Despite evidence that breast cancer screening effectively diagnoses and treats cancer through early detection, mammography use remains low in Taiwan. We applied the health belief model (HBM) and the knowledge-attitude-behavior (KAB) model as theoretical frameworks to examine factors associated with mammography uptake among women aged 45-69 years in Taiwan. A cross-sectional survey January-July 2018 was conducted of women aged 45-69 years in five southern Taiwan health institutions. Survey questionnaires included demographics, HBM constructs, and health knowledge regarding breast cancer and screening. Multivariable logistic regression models explored the mediation effects of HBM constructs between health knowledge and mammography use. The final analytical sample included 621 women; 67 did not receive mammography and 554 received mammography. When the regression model was adjusted only for demographic factors, women with adequate health knowledge were more likely to undergo mammography (AOR = 2.321, 95%CI = 1.141-3.809); in regression models including health knowledge and HBM constructs, the likelihood effect of health knowledge declined and became insignificant (AOR = 1.711, 95%CI = 0.985-2.972), indicating potential mediation effects between health knowledge and up-to-date mammography use. Overall, based on the HBM and the KAB theoretical framework, our data support that health belief played a substantial mediating role in the association between health knowledge and mammography uptake, in particular perceived barriers and cues to action in the HBM, which were modifying factors of health beliefs. Therefore, to improve mammography uptake, it may be helpful to design educational model-based interventions through tackling those modifiable perceived barriers and enhancing the intensity of external cues to action.
尽管有证据表明乳腺癌筛查通过早期发现有效地诊断和治疗癌症，但在台湾，乳房 X 光摄影的使用仍然很低。我们应用健康信念模型（HBM）和知识-态度-行为（KAB）模型作为理论框架，来检验与台湾 45-69 岁女性乳房 X 光摄影检查率相关的因素。2018 年 1 月至 7 月，在台湾南部的五家医疗机构中进行了一项针对 45-69 岁女性的横断面调查。调查问卷包括人口统计学、HBM 结构以及有关乳腺癌和筛查的健康知识。多变量逻辑回归模型探讨了 HBM 结构在健康知识和乳房 X 光摄影检查之间的中介作用。最终分析样本包括 621 名女性；其中 67 人未接受乳房 X 光摄影检查，554 人接受了乳房 X 光摄影检查。当仅调整人口统计学因素的回归模型时，健康知识充足的女性更有可能接受乳房 X 光摄影检查（AOR=2.321，95%CI=1.141-3.809）；在包含健康知识和 HBM 结构的回归模型中，健康知识的影响作用下降且变得无统计学意义（AOR=1.711，95%CI=0.985-2.972），表明健康知识与最新乳房 X 光摄影检查使用率之间存在潜在的中介作用。总体而言，基于 HBM 和 KAB 理论框架，我们的数据支持健康信念在健康知识与乳房 X 光摄影检查率之间的关联中发挥了重要的中介作用，特别是 HBM 中的感知障碍和行动线索，这些是健康信念的调节因素。因此，为了提高乳房 X 光摄影检查率，通过解决那些可调节的感知障碍和增强外部行动线索的强度，设计基于教育模式的干预措施可能会有所帮助。
