The role of the self-concept in influencing mammography screening behavior of older women.

Abstract

While many older adults participate in health protective behaviors, older women, especially those at highest risk, often do not exhibit regular mammography screening behavior. This study's primary aim was to explore the contribution of the self-concept to adherence to regular mammography screening guidelines through model fitting strategies. The PRECEDE model was augmented with Health Belief Model and self theory constructs. Predisposing (barrier, benefit and susceptibility beliefs, personal and family/friend history of breast problems, self-concept, self-efficacy, demographics); enabling (type/source of health care, recent clinical breast examination and pap test); and reinforcing factors (physician recommendation, knowledge of peers as screeners) were assessed. The self-concept was operationalized in three ways, (1) the presence of salient hoped-for and feared possible selves; (2) total number possible selves; and (3) balanced pairs of possible selves. Two hundred and ten women aged 50-75 years (mean 66.7 years) were recruited from community and women's groups. The women completed a questionnaire consisting of open and closed-ended self questions and mammography-related items. Data analyses were conducted on those eligible (N = 198) using qualitative and quantitative methods. Three-quarters of the sample identified health as an important self domain, with women 50-69 years endorsing a feared health-related possible self more often and women 70-75 years endorsing a hoped-for health-related possible self more often. Fifty-two percent of the sample was adherent to mammography screening guidelines. In logistic regression analyses, only feared health-related possible self, feared self-efficacy in the feared domain and the two factor interaction term were found among the self-concept measures to be associated with regular adherence to mammography screening guidelines. The likelihood ratio test statistic revealed that the addition of the self measures significantly improved the overall fit of the model. More specifically, predictors of adherence to mammography screening guidelines were clinical breast examination, physician recommendation, age, barriers, benefits, as well as feared health-related possible self, self-efficacy in the feared domain and the interaction term. The presence of a feared health-related possible self increased the odds of adherence, when self-efficacy in the feared domain was high, but not when self-efficacy was low. Other self domains did not predict screening. The concept of the self was found to contribute to health behavior research and is worthy of further study.