Skip to main content

Advertisement

Log in

Affective associations and cognitive beliefs relate to individuals’ decisions to perform testicular or breast self-exams

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Affective associations with behavioral practices play an important role in individuals’ uptake of a variety of health behaviors. Most work has looked at individual behavioral practices with a direct impact on health; because screening behaviors are conceptually distinct from such behaviors, it is important to examine the interplay of affect and cognition in screening decision making. The current research explored affective and cognitive predictors of testicular and breast self-examination behavior. Young adult participants (N = 184) reported cognitive beliefs and affective associations with testicular self-exam behavior (male participants) and breast self-exam behavior (female participants) and reported their own current screening behavior. In univariable models, affective associations were related to screening behavior for both testicular self-exams and breast self-exams. When examining affective associations and cognitive beliefs as simultaneous predictors, affective associations (but not cognitive beliefs) predicted testicular self-exams, and neither affective associations nor cognitive beliefs were uniquely related to breast self-exams. Moreover, for testicular self-exams, affective associations mediated the relation between cognitive beliefs and screening behavior; no mediation was present for breast self-exam behavior. These findings suggest three potential outcomes: first, that greater consideration of affective associations in testicular self-exam screening decisions may be warranted; second, that breast and testicular self-exams may have different antecedents; and third, that incorporation of affective factors in intervention design might have merit for increasing engagement in some cancer screening behaviors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  1. The full set of affectively valenced words included: Hateful, love, sad, joy, annoyed, happy, tense, calm, bored, excited, angry, relaxed, disgusted, acceptance, and embarrassed.

  2. The full set of cognitively valenced words included: Useless, useful, foolish, wise, unsafe, safe, harmful, beneficial, worthless, valuable, imperfect, perfect, unhealthy, and wholesome.

  3. The predictor variables are measures of current affective associations and cognitive beliefs, and the behavioral measure is the number of self-exams performed over the past 12 months. This is in keeping with other cross-sectional behavioral health reports (e.g., diet over the past 30 days, visits to the doctor within the past year) and is an easily understood timeframe for reporting for screening behaviors that are relatively infrequent (i.e., monthly) and occur on a non-fixed schedule. This technique has been used for breast self-exam behaviors in several previous studies (Miller et al., 1996; Moser et al., 2007).

References

  • Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.

    Article  Google Scholar 

  • Ajzen, I. (2002). Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. Journal of Applied Social Psychology, 32, 665–683. doi:10.1111/j.1559-1816.2002.tb00236.x

    Article  Google Scholar 

  • Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting behavior. Englewood Cliffs, NJ: Prentice Hall.

    Google Scholar 

  • American Cancer Society (2014a). Breast cancer. Retrieved Oct. 17, 2014 from http://www.cancer.org/acs/groups/cid/documents/webcontent/003090-pdf.pdf

  • American Cancer Society (2014b). Testicular cancer. Retrieved Oct. 17, 2014 from http://www.cancer.org/acs/groups/cid/documents/webcontent/003142-pdf.pdf

  • Berry, D. A., Cronin, K. A., Plevritis, S. K., Fryback, D. G., Clarke, L., Zelen, M., et al. (2005). Effect of screening and adjuvant therapy on mortality from breast cancer. New England Journal of Medicine, 353, 1784–1792.

    Article  CAS  PubMed  Google Scholar 

  • Cameron, L. D., & Leventhal, H. (2003). The self-regulation of health and illness behaviour. New York: Routledge.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2013). Deaths: Final data for 2010. National Vital Statistics Reports, 61, 1–118.

    Google Scholar 

  • Champion, V. L. (1999). Revised susceptibility, benefits, and barriers scale for mammography screening. Research in Nursing & Health, 22, 341–348.

    Article  CAS  Google Scholar 

  • Consedine, N. S., Horton, D., Ungar, T., Joe, A. K., Ramirez, P., & Borrell, L. (2007). Fear, knowledge, and efficacy beliefs differentially predict the frequency of digital rectal examination versus prostate specific antigen screening in ethnically diverse samples of older men. American Journal of Men’s Health, 1, 29–43. doi:10.1177/1557988306293495

    Article  PubMed  Google Scholar 

  • Crites, S. L., Fabrigar, L. R., & Petty, R. E. (1994). Measuring the affective and cognitive properties of attitudes: Conceptual and methodological issues. Personality and Social Psychology Bulletin, 20, 619–634.

    Article  Google Scholar 

  • Dillard, A. J., Ubel, P. A., Smith, D. M., Zikmund-Fisher, B. J., Nair, V., Derry, H. A., et al. (2011). The distinct role of comparative risk perceptions in a breast cancer prevention program. Annals of Behavioral Medicine, 42, 262–268. doi:10.1007/s12160-011-9287-8

    Article  PubMed Central  PubMed  Google Scholar 

  • Ferrer, R. A., Fisher, J. D., Buck, R., & Amico, K. R. (2011). Pilot test of an emotional education intervention component for sexual risk reduction. Health Psychology, 30, 656–660. doi:10.1037/a0023438

    Article  PubMed  Google Scholar 

  • Hay, J. L., McCaul, K. D., & Magnan, R. E. (2006). Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Preventive Medicine, 42, 401–408. doi:10.1016/j.ypmed.2006.03.002

    Article  PubMed  Google Scholar 

  • Hayes, A. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. http://www.afhayes.com/public/process2012.pdf

  • Janssen, E., Waters, E. A., van Osch, L., Lechner, L., & de Vries, H. (2014). The importance of affectively-laden beliefs about health risks: The case of tobacco use and sun protection. Journal of Behavioral Medicine, 37, 11–21. doi:10.1007/s10865-012-9462-9

    Article  PubMed Central  PubMed  Google Scholar 

  • Keer, M., van den Putte, B., & Neijens, P. (2012). The interplay between affect and theory of planned behavior variables. American Journal of Health Behavior, 36, 107–115.

    Article  PubMed  Google Scholar 

  • Kiviniemi, M. T., Bennett, A., Zaiter, M., & Marshall, J. R. (2011). Decision making for colorectal cancer screening: What do we know about theoretical models of decision making? Psycho-Oncology, 20, 1023–1033.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kiviniemi, M. T., & Bevins, R. (2007). Affect-behavior associations in motivated behavioral choice: Potential transdisciplinary links. In P. R. Zelick (Ed.), Issues in the Psychology of Motivation (pp. 65–80). Hauppage, NY: Nova.

    Google Scholar 

  • Kiviniemi, M. T., & Brown-Kramer, C. R. (in press). Planning versus action: Different decision-making processes predict plans to change one’s own diet versus actual dietary behavior. Journal of Health Psychology.

  • Kiviniemi, M. T., & Duangdao, K. M. (2009). Affective associations mediate the influence of cost-benefit beliefs on fruit and vegetable consumption. Appetite, 52, 771–775.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kiviniemi, M. T., Hay, J. L., James, A. S., Lipkus, I. M., Meissner, H. I., Stefanek, M., et al. (2009). Decision making about cancer screening: An assessment of the state of the science and a suggested research agenda. Cancer Epidemiology, Biomarkers and Prevention, 18, 3133–3137.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kiviniemi, M. T., Jandorf, L., & Erwin, D. O. (2014). Disgusted, embarrassed, annoyed: Affective associations relate to uptake of colonoscopy screening. Annals of Behavioral Medicine, 48, 112–119. doi:10.1007/s12160-013-9580-9

    Article  PubMed  Google Scholar 

  • Kiviniemi, M. T., Saad-Harfouche, F. G., Ciupak, G. L., Davis, W., Moysich, K., Hargrave, N. C., et al. (2013). Pilot intervention outcomes of an educational program for biospecimen research participation. Journal of Cancer Education, 28, 52–59. doi:10.1007/s13187-012-0434-0

    Article  PubMed Central  PubMed  Google Scholar 

  • Kiviniemi, M. T., Voss-Humke, A. M., & Seifert, A. L. (2007). How do I feel about the behavior? The interplay of affective associations with behaviors and cognitive beliefs as influences on physical activity behavior. Health Psychology, 26, 152–158.

    Article  PubMed  Google Scholar 

  • Lawton, R., Conner, M., & McEachan, R. (2009). Desire or reason: Predicting health behaviors from affective and cognitive attitudes. Health Psychology, 28, 56–65.

    Article  PubMed  Google Scholar 

  • Ling, A. M. C., & Horwath, C. (2001). Perceived benefits and barriers of increased fruit and vegetable consumption: Validation of a decisional balance scale. Journal of Nutrition Education, 33, 257.

    Article  Google Scholar 

  • Liu, K., Daviglus, M. L., Loria, C. M., Colangelo, L. A., Spring, B., Moller, A. C., & Lloyd-Jones, D. M. (2012). Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: The Coronary Artery Risk Development in (Young) Adults (CARDIA) study. Circulation, 125, 996–1004.

    Article  PubMed Central  PubMed  Google Scholar 

  • MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. New York: Lawrence Erlbaum Associates.

    Google Scholar 

  • McCaul, K. D., Branstetter, A. D., Schroeder, D. M., & Glasgow, R. E. (1996a). What is the relationship between breast cancer risk and mammography screening? A meta-analytic review. Health Psychology, 15, 423–429.

    Article  CAS  PubMed  Google Scholar 

  • McCaul, K. D., Schroeder, D. M., & Reid, P. A. (1996b). Breast cancer worry and screening: Some prospective data. Health Psychology, 15, 430–433. doi:10.1037/0278-6133.15.6.430

    Article  CAS  PubMed  Google Scholar 

  • McCaul, K. D., & Tulloch, H. E. (1999). Cancer screening decisions. Journal of the National Cancer Institute, 25, 52–58.

    Article  PubMed  Google Scholar 

  • Miller, S. M., Shoda, Y., & Hurley, K. (1996). Applying cognitive-social theory to health-protective behavior: Breast self-examination in cancer screening. Psychological Bulletin, 119, 70–94.

    Article  CAS  PubMed  Google Scholar 

  • Moser, R. P., McCaul, K., Peters, E., Nelson, W., & Marcus, S. E. (2007). Associations of perceived risk and worry with cancer health-protective actions. Journal of Health Psychology, 12, 53–65. doi:10.1177/1359105307071735

    Article  PubMed  Google Scholar 

  • Rothman, A. J., & Salovey, P. (1997). Shaping perceptions to motivate healthy behavior: The role of message framing. Psychological Bulletin, 121, 3–19.

    Article  CAS  PubMed  Google Scholar 

  • Schwartz, M. D., Lerman, C., Brogan, B., Peshkin, B. N., Isaacs, C., DeMarco, T., et al. (2005a). Utilization of BRCA1/BRCA2 mutation testing in newly diagnosed breast cancer patients. Cancer Epidemiology, Biomarkers and Prevention, 14, 1003–1007.

    Article  CAS  PubMed  Google Scholar 

  • Schwartz, M. D., Peshkin, B. N., Tercyak, K. P., Taylor, K. L., & Valdimarsdittor, H. (2005b). Decision making and decision support for hereditary breast-ovarian cancer susceptibility. Health Psychology, 24, S78–S84. doi:10.1037/0278-6133.24.4.S78

    Article  PubMed  Google Scholar 

  • Schwartz, M. D., Taylor, K. L., & Willard, K. S. (2003). Prospective association between distress and mammography utilization among women with a family history of breast cancer. Journal of Behavioral Medicine, 26, 105-117. doi:0160-7715/03/0400-0105/0

  • Steinhardt, M. A., & Dishman, R. K. (1989). Reliability and validity of expected outcomes and barriers for habitual physical activity. Journal of Occupational Medicine, 31, 536–546.

    Article  CAS  PubMed  Google Scholar 

  • Subramanian, S., Klosterman, M., Amonkar, M. M., & Hunt, T. L. (2004). Adherence with colorectal cancer screening guidelines: A review. Preventive Medicine, 38, 536–550.

    Article  PubMed  Google Scholar 

  • Swan, J., Breen, N., Graubard, B. I., McNeel, T. S., Blackman, D., Tangka, F. K., & Ballard-Barbash, R. (2010). Data and trends in cancer screening in the United States: Results from the 2005 National Health Interview Survey. Cancer, 116, 4872–4881.

    Article  PubMed Central  PubMed  Google Scholar 

  • van Dijk, S., Otten, W., Zoeteweij, M. W., Timmermans, D. R., van Asperen, C. J., Breuning, M. H., et al. (2003). Genetic counselling and the intention to undergo prophylactic mastectomy: Effects of a breast cancer risk assessment. British Journal of Cancer, 88, 1675–1681.

    Article  PubMed Central  PubMed  Google Scholar 

  • Vernon, S. W. (1997). Participation in colorectal cancer screening: A review. Journal of the National Cancer Institute, 89, 1406–1422. doi:10.1093/jnci/89.19.1406

    Article  CAS  PubMed  Google Scholar 

  • Walsh, E. M., & Kiviniemi, M. T. (2014). Changing how I feel about the food: experimentally manipulated affective associations with fruits change fruit choice behaviors. Journal of Behavioral Medicine, 37, 322–331.

    Article  PubMed Central  PubMed  Google Scholar 

  • Walsh, J. M. E., & Terdiman, J. P. (2003). Colorectal cancer screening: Scientific review. Journal of the American Medical Association, 289, 1288–1296.

    Article  PubMed  Google Scholar 

  • Webb, T. L., & Sheeran, P. (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological Bulletin, 132, 249–268.

    Article  PubMed  Google Scholar 

  • Weinstein, N. D. (1993). Testing four competing theories of health-protective behavior. Health Psychology, 12, 324–333.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

Carolyn R. Brown-Kramer and Marc T. Kiviniemi declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carolyn R. Brown-Kramer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brown-Kramer, C.R., Kiviniemi, M.T. Affective associations and cognitive beliefs relate to individuals’ decisions to perform testicular or breast self-exams. J Behav Med 38, 664–672 (2015). https://doi.org/10.1007/s10865-015-9641-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-015-9641-6

Keywords

Navigation