Psychological predictors of intention and avoidance of attending organized mammography screening in Norway: applying the Extended Parallel Process Model

Abstract

Background: Mammography screening is the main method for early detection of breast cancer in Norway. Few studies have focused on psychological determinants of both attendance and non-attendance of publicly available mammography screening programs. The aim of the current study, guided by the Extended Parallel Process Model, was to examine how psychological factors influence defensive avoidance of breast cancer screening and intention to attend mammography.

Methods: Cross-sectional survey data from a community sample of women living in Norway aged ≥ 18 (N = 270), and without a history of breast cancer, was collected from September 2018 to June 2019 and used to investigate the relationships between the Extended Parallel Process Model (EPPM) constructs and two outcomes: defensive avoidance of breast cancer screening and intention to attend mammography within the next two years. After adjusting for confounding factors, the hierarchical multiple linear regression analyses was conducted to assess the ability of the independent variables based on the EPPM to predict the two outcome variables. Significance level was chosen at p < 0.05.

Results: Multivariate analyses showed that defensive avoidance of breast cancer screening was predicted by lower perceived susceptibility to breast cancer (β = - 0.22, p = 0.001), lower response efficacy of mammography screening (β = - 0.33, p = 0.001), higher breast cancer fear (β = 0.15, p = 0.014), and checking breasts for lumps (β = - 0.23, p = 0.001). Intention to attend mammography within the next two years was predicted by higher response efficacy of mammography screening (β = 0.13, p = 0.032), having a lower educational level (β = - 0.10, p = 0.041), and regular previous mammography attendance compared to never attending (β = 0.49, p = 0.001).

Conclusions: The study revealed that defensive avoidance of breast cancer screening and intention to attend mammography were not predicted by the same pattern of psychological factors. Our findings suggest future health promotion campaigns need to focus not only on the psychological factors that encourage women's decision to attend the screening, but also to counter factors that contribute to women's decision to avoid it.

Keywords: Breast cancer screening; Defensive avoidance; Extended parallel process model; Intention; Mammography; Psychological predictors.

Fig. 1

Adapted version of the Extended Parallel Process Model to predict mammography screening in the current study