The preventive screening paradigm: Development and empirical application

Abstract

A five-tenet theoretical framework designed to explain cancer screening behavior was developed, operationalized and applied to examine cervical cancer screening in a secondary data analysis of 500 women. The primary purpose was to investigate the explanatory power of the paradigm in accounting for variance in pap smear screening frequency. The tenets of the model, Salience of Disease Outcome, Mediating Cognitions, Efficacy and Control, Access to Health Care Resources, and Role of Sociodemographic and Biomedical Variables, were measured via the interview instrument of the parent study, Effects of Race and Social Factors on Stage at Diagnosis. Participants were 500 black and white women, with a mean age of 60, who had been diagnosed with breast, uterine or colorectal cancer in Connecticut hospitals.;Each tenet was examined independently with respect to the rationale for its inclusion, hypotheses regarding its relationship to the dependent variable, results of univariate and bivariate statistics, and results of a multivariate stepwise linear regression. The five tenets of the paradigm were then integrated into one analysis, by assembling the strongest predictors from the five independent regressions. The integrated regression model was applied in the sample as a whole and in stratified subsets of the population.;Results indicated that six variables (having seen a gynecologist during the year prior, years of smoking, race, use of hormone replacement, marital status, and family income) together accounted for over 36% of the variance in pap smear frequency. A four variable model explained 37% of the variance for white women, and a five variable model explained 37% of the variance for black women. The model was best equipped to explain pap smear behavior in women under age 50, where five.variables accounted for over 59% of the variance in pap smear frequency. The paradigm was least equipped (15%) to account for pap smear behavior in women who did not see a gynecologist in the year prior.;Substantive implications of these findings, with respect to promoting compliance with cervical cancer screening, and heuristic implications regarding the explanatory fortitude of the Preventive Screening Paradigm are discussed.