Journal of Behavioral Medicine

, Volume 17, Issue 4, pp 391–406 | Cite as

Health belief model variables as predictors of screening mammography utilization

  • Ruth Bernstein Hyman
  • Stephen Baker
  • Robert Ephraim
  • Alyson Moadel
  • Joanne Philip


Despite its efficacy, screening mammography is not widely utilized due to various factors. The Health Belief Model (HBM) has previously been used as one conceptualization of relevant patient attitudes. No psychometrically validated measure of these variables has previously been utilized, however, nor have prospective studies of women all of whom have been referred by their physicians for mammography been reported. The research reported here addressed both of those issues. A psychometrically validated measure of the HBM variables, perceived susceptibility, barriers, and benefits, was used. along with age, education, ethnicity, and family breast cancer history to predict mammography utilization in a prospective study of hospital employees. Being white, perceiving fewer benefits of and barriers to mammography, and having a family history of breast cancer were predictive of noncompliance. The avoidant behavior of employees with a family history of breast cancer must be addressed in attempts to increase mammography utilization. In addition, results of the study imply the need for full discussion with women referred for mammography of all issues related to its use, both its benefits and possible barriers.

Key Words

screening mammography health belief model patient attitudes 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Cancer Society National Task Force on Breast Cancer Control (1984).Mammography: Two Statements of the American Cancer Society, American Cancer Society, New York.Google Scholar
  2. Anda, R. F., Sienko, D. G., Remington, P. L., Gentry, E. M., and Marks, J. S. (1990). Screening mammography for women 50 years of age and older: Practices and trends, 1987.Am. J. Prev. Med. 6: 123–129.PubMedGoogle Scholar
  3. Bailar, J. C. (1988). Mammography before age 50 years.JAMA, 259: 1548–1549.PubMedGoogle Scholar
  4. Bassett, L. W., Bunnell, D. H., Cerny, J. A., and Gold, R. H. (1986). Screening mammography: Referral practices of Los Angeles physicians.AJR 147: 689–692.PubMedGoogle Scholar
  5. Bastani, R., Marcus, A. C., and Hollatz-Brown, A. (1991). Screening mammography rates and barriers to use: A Los Angeles County survey.Prev. Med. 20: 350–363.PubMedGoogle Scholar
  6. Burack, R. C., and Liang, J. (1987). The early detection of cancer in the primary-care settint: Factors associated with the acceptance and completion of recommended procedures.Prev. Med. 16: 739–751.PubMedGoogle Scholar
  7. Burack, R. C., and Liang, J. (1989). The acceptance and completion of mammography by older black women.Am. J. Public Health 79: 721–726.PubMedGoogle Scholar
  8. Calnan, M. (1984). The health belief model and participation in programmes for the early detection of breast cancer: A comparative analysis.Soc. Sci. Med. 19: 823–830.PubMedGoogle Scholar
  9. Eddy, D. M. (1989). Screening for breast cancer.Ann. Intern. Med. 5: 389–399.Google Scholar
  10. Eddy, D. M., Hasselblad, V., Mogivney, W., and Hendee, W. (1988). The value of mammography screening in women under age 50 years.JAMA 259: 1512–1519.PubMedGoogle Scholar
  11. Farley, T. A., and Flannery, J. T. (1989). Late-stage diagnosis of breast cancer in women of lower socioeconomic status.Am. J. Public Health 79: 1508–1512.PubMedGoogle Scholar
  12. Fink, R., Shapiro, S., and Lewison, J. (1968). The reluctant participant in a breat cancer screening program.Public Health Rep. 83: 479–490.PubMedGoogle Scholar
  13. Fletcher, S. W., Morgan, T. M., O'Malley, M. S., Earp, A. L., and Degnan, D. (1989). Is breast self-examination predicted by knowledge, attitudes, beliefs, or sociodemographic characteristics.Am. J. Prev. Med. 5: 207–215.PubMedGoogle Scholar
  14. Fox, S. A., Baum, J. K., Klos, D. S., and Tsou, C. V. (1985). Breast cancer screening: The underuse of mammography.Radiology 156: 687–611.Google Scholar
  15. Fox, S. A., Klos, D. S., and Tsou, C. V. (1988). Underuse of screening mammography by family physicians.Radiology 166: 431–433.PubMedGoogle Scholar
  16. Fox, S. A., Murata, P. J., and Stein, J. A. (1991). The impact of physician complicance on screening mammography of older women.Arch. Int. Med. 151: 50–56.Google Scholar
  17. Gold, R. H., Basset, L. W., and Fox, S. A. (1987). Mammography screening: Successes and problems in implementing widespread use in the United States.Radiol. Clin. North Am. 25: 1039–1046.PubMedGoogle Scholar
  18. Gorsuch, R. L. (1983).Factor Analysis, 2nd ed., Lawrence Erlbaum Associates, Hillsdale, NJ.Google Scholar
  19. Hyman, R. B., and Baker, S. (1992). Construction of the Hyman-Baker Mammography Questionnaire, a measure of Health Belief Model variables;Psychol. Rep. 71: 1203–1215.PubMedGoogle Scholar
  20. Janz, N. K., and Becker, M. H. (1984). The health belief model: A decade later.Health Educ. Q. 11: 1–47.PubMedGoogle Scholar
  21. Kelly, P. T. (1979). Breast self-examinations: Who does them and why.J. Behav. Med. 1: 31–38.Google Scholar
  22. Kruse, J., and Philips, D. M. (1987). Factors influencing women's decision to undergo mammography.Obstet. Gynecol. 70: 744–748.PubMedGoogle Scholar
  23. Lane, D. S., and Fine, H. L. (1983). Complicance with mammography referrals.N.Y. State J. Med. 83: 173–176.PubMedGoogle Scholar
  24. Lerman, C., Rimer, B., Trock, B., Balshem, A., and Engstrom, P. F. (1990). Factors associated with repeat adherene to breast cancer screening.Prev. Med. 19: 279–290.PubMedGoogle Scholar
  25. Lurie, N., Manning, W. G., Peterson, C., Goldberg, G. A., Phelps, C. A., and Lillard, L. (1987). Preventive care: Do we practive what we preach?.Am. J. Public Health 77: 801–804.PubMedGoogle Scholar
  26. Mann, L. C., Hawes, D. R., Ghods, M., Bednar, E. J., and Potchen, E. J. (1987). Utilization of screening mammography: Comparison of different physician specialties.Radiology 164: 121–122.PubMedGoogle Scholar
  27. McCusker, J., and Morrow, G. R. (1980). Factors related to the use of cancer early detection techniques.Prev. Med. 9: 388–397.PubMedGoogle Scholar
  28. Morbidity and Mortality Weekly Report (1990). Use of mammography — United States, 1990.Morbid. Mortal Week Rep. 39: 621, 627–630.Google Scholar
  29. National Cancer Institute (1987).Working Guidelines for Early Cancer Detection: Rationale and Supporting Evidence to Decrease Mortality. U. S. Department of Health and Human Service, Public Health Service, Washington, DC.Google Scholar
  30. National Institutes of Health (1981). Survey finds U.S. women knowledgeable about breast cancer.JAMA 245: 918.Google Scholar
  31. Nattinger, A. B., Panzer, R. J., and Janus, J. (1989). Improving the utilization of screening mammography in primary care practices.Arch. Intern. Med. 149: 2087–2092.PubMedGoogle Scholar
  32. NCI Breast Cancer Screening Consortium (1990). Screening mammography: A missed clinical opportunity.JAMA 264: 54–58.Google Scholar
  33. Nunnally, J. C. (1978).Psychometric Theory, McGraw-Hill, New York.Google Scholar
  34. Rimer, B. K., Davis, S. W., Engstrom, P. F., Meyers, R. E., and Rosan, J. R. (1988). Some reasons for compliance and noncompliance in a health maintenance organization breast cancer screening program.J. Compliance Health Care 3: 103–114.PubMedGoogle Scholar
  35. Rimer, B. K., Engstrom, P. F., Keintz, M. K., Meyers, R. E., and Rosan, J. (1989a). Barriers and facilitators to compliance with routine mammographic screening.Ad. Cancer Control Innov. Res. 125–133.Google Scholar
  36. Rimer, B. K., Keintz, M. K., Kessler, H. B., Engstrom, P. F., and Rosan, J. R. (1989b). Why women resist screening mammography: Patient-related barriers.Radiology 172: 243–246.PubMedGoogle Scholar
  37. Rimer, B. K., Trock, B., Blashem, A., Engstrom, P. F., Rosan, J., and Lerman, C. (1990). Breast screening practices among primary physicians: Reality and potential.J. Am. Board Fam. Pract. 3: 26–34.PubMedGoogle Scholar
  38. Rippetoe, P. A., and Rogers, R. W. (1987). Effects of components of protection-motivaton theory on adaptive and maladaptive coping with a health threat.J. Pers. Soc. Psychol. 52: 596–604.PubMedGoogle Scholar
  39. Rosenstock, I. M. (1966). Why people use health services.Milbank Q. 44: 94–127.Google Scholar
  40. Sauners, D. L. (1989). Differences in the timeliness of diagnosis, breast and cervical cancer, San Francisco 1974-85.Am. J. Public Health 79: 69–70.PubMedGoogle Scholar
  41. Schwoon, D. R., and Schmoll, H. J. (1979). Motivation to participate in cancer screening programmes.Soc. Sci. Med. 13A: 283–286.PubMedGoogle Scholar
  42. Sickles, E. A. (1988). Impact of low-cost mammography screening on nearby mammography practices.Radiology 168: 59–61.PubMedGoogle Scholar
  43. Stillman, M. J. (1977). Women's health beliefs about breast cancer and breast self-examination.Nurs. Res. 26: 121–127.PubMedGoogle Scholar
  44. Tabachnick, B. G., and Fidell, L. S. (1989).Using Multivariate statistics, 2nd ed., Harper Collins, New York.Google Scholar
  45. Taplin, S., Anderman, C., and Grothaus, L. (1989). Breast cancer risk and participation in mammographic screening.Am. J. Public Health 79: 1494–1498.PubMedGoogle Scholar
  46. Tatsuoka, M. M. (1970).Selected Topics in Advanced Statistics: Discriminant Analysis, Institute for Personality and Ability Testing, Champaign, IL.Google Scholar
  47. Vernon, S. W., Laville, E. A., and Jackson, G. L. (1990). Participation in breast screening programs. A review.Soc. Sci. Med. 30: 1107–1118.PubMedGoogle Scholar
  48. Wheat, M. E., Kunitz, G., and Fisher, J. (1990). Cancer screening in women: A study of house staff behavior.Am. J. Prev. Med. 6:130–136.PubMedGoogle Scholar
  49. Zapka, J. G., Costanza, M. E., and Greene, H. L. (1989). Breast cancer screening by mammography: Utilization and associated factors.Am. J. Public Health 79: 1499–1502.PubMedGoogle Scholar
  50. Zapka, J. G., Costanza, M. E., Stoddard, A., and Green, H. L. (1990). Breast cancer screening: Perceptions and experience of primary care physicians, radiologists and women.Adv. Prog. Clin. Biol. Res. 339: 253–257.Google Scholar

Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • Ruth Bernstein Hyman
    • 1
  • Stephen Baker
    • 2
  • Robert Ephraim
    • 3
  • Alyson Moadel
    • 1
    • 4
  • Joanne Philip
    • 5
  1. 1.Department of Epidemiology and Social MedicineAlbert Einstein College of MedicineBronx
  2. 2.Department of RadiologyNew Jersey Medical School-UMDNJUSA
  3. 3.Department of Community MedicineMt. Sinai HospitalNew York
  4. 4.Ferkauf Graduate School of PsychologyYeshiva UniversityBronx
  5. 5.Department of RadiologyJack D. Weiler Hospital of Albert Einstein College of MedicineBronx

Personalised recommendations