Factors Influencing Female Breast Cancer Screening Behavior Based On The Health Ecological Model

Objective:The purpose of this study was to investigate the situation of breast cancer screening,and to explore the influencing factors and the interaction mechanisms of women’s breast cancer screening behaviors based on the health ecological model,which can provide reference and basis for formulating comprehensive intervention strategies to increase breast cancer screening rates.Methods:By means of convenient sampling,a total of 480 eligible community women in Changchun,Jilin Province were invited to participate in a formal survey between November 2019 and March2020.Research instruments included the sociodemographic data questionnaire,Chinese Version of Breast Cancer Awareness Measurement,Health Belief Model Scale,General Self-Efficacy Scale,Perceived Social Support Scale,Medical Care Satisfaction Scale,Perceived Nursing Service Quality Scale,as well as Patients’Trust Behavior and Attitude Scale.Epidata3.1 and SPSS24.0 statistics software were used for inputting and analyzing data,respectively.Frequency and percentage were used to describe women’s sociodemographic data and breast cancer screening behavior;median（Me）and interquartile ranges(P₂₅,P₇₅)were used to describe the scores of social psychological factors that influence women’s breast cancer screening behavior（in this study,the instruments scores were all non-normal distribution）;X²test was used to compare the sociodemographic data of the two groups（screened and unscreened）;Mann-Whitney U test was used to compare the scores of social psychological factors that influence women’s breast cancer screening behavior between the two groups（screened and unscreened）;and binary logistic regression analysis was used to investigate the factors influencing breast cancer screening behaviors;Finally,based on the health ecological model,Mplus8.3 was applied to establish a structural equation model（SEM）to explore the pathway relationship between social psychological factors and breast cancer screening behavior.Results:1.A total of 470 women were recruited for the study,of which 259（55.1%）received breast cancer screening in the past two years.Among the women in the screened group,57.3%received breast ultrasound as the most commonly used screening method,followed by clinical breast examinations（27.3%）.2.The result of the X² test and Mann-Whitney U test showed that age,BMI,chronic diseases history,breast disease history,physical exercise,physical examination,social support,breast cancer awareness,health belief of breast cancer screening,self-efficacy of breast cancer screening,household income,satisfaction with doctors’services,satisfaction with nurses’services and trust in doctor had statistically significant impact on women’s breast cancer screening behavior（P<0.05）.3.The result of the binary logistic regression analysis indicated that breast cancer awareness,self-efficacy of breast cancer screening,social support,satisfaction with doctors’services and trust in doctor can positively predict women’s breast cancer screening behavior,and the difference was statistically significant（P<0.05）.Finally,the logistic regression model can explain 94.5%of the variation in women’s breast cancer screening behaviors.4.The adaptability indexes of the SEM were:X²/df=2.95,CFI=0.95,TLI=0.93,RMSEA=0.06,SRMR=0.03,which can reflect the path relationship between social psychology factors and breast cancer screening behavior well.The results of the SEM showed that the psychological factors of breast cancer screening（β=0.232）,social support（β=0.719）and the evaluation with healthcare providers（β=0.147）can directly and positively predict breast cancer screening behaviors;social support（β=0.072）and the evaluation with healthcare providers（β=0.034）can indirectly predict breast cancer screening behavior through psychological factors of breast cancer screening.Conclusion:1.Women’s breast cancer screening rate was not optimistic,so attention must be paid to improving women’s breast cancer screening compliance.2.Breast cancer awareness,self-efficacy of breast cancer screening,social support,satisfaction with doctors’services and trust in doctor can positively predict screening behavior.Researchers should focus on these variables when developing interventions to increase women’s breast cancer screening rate,to formulate more scientific and effective interventions.3.The health ecological model performed a better explanation about social psychology factors that influence women’s breast cancer screening behavior.By constructing the SEM,we found that the psychological factors of breast cancer screening,social support and the evaluation with healthcare providers significantly affected breast cancer screening behaviors;social support and the evaluation with healthcare providers can indirectly influence breast cancer screening behavior through psychological factors of breast cancer screening.Researchers can develop comprehensive interventions based on the five levels of the health ecological model,especially the role of social support,so as to maximize women’s breast cancer screening rates.