Breast-Cancer Self-Protective Motivations of African-American Women: Assessing Comparative Risk, Benefits, Barriers, and Subjective Norms

Theoretical Background and research questions/hypothesis:   While white women have the highest incidence of breast cancer, African-American women are most likely to die from the disease, largely due to interrelated factors including barriers to early detection and unequal access to improvements in cancer treatment (Cancer Health Disparities, 2012). The theory of planned behavior (TPB, Ajzen, 2002) has been supported to examine behavior change in a range of health domains. Further, major health behavior change models (Health Belief Model, Janz & Becker, 1984) have incorporated perceived risk (an individual's perception of susceptibility toward that health risk as well as their perception of the severity of the health risk) as an antecedent of preventive health behaviors. The central belief underlying this relationship is that perceptions of risk for a negative health outcome encourage preventative health behaviors to avoid the negative outcome (for a meta-analyses see Brewer, Chapman, Gibbons, Gerrard, McCaul, & Weinstein, 2007). This study applies a modified theory of planned behavior theoretical framework to ask: Do comparative risk susceptibility and severity contribute to the self-protective motivations of African-American women? Do benefits, barriers, and subjective norms contribute to the self-protective motivations (SPM) of African-American women after assessing the contribution of comparative susceptibility and severity?

Methods:  A non-probability sample (N = 77) of asymptotic African-American women 40 years and older who had never been previously diagnosed with breast cancer recruited through the assistance of local churches About 31% of participants were between 40—49 years of age (M = 50—59 years, SD = 1.29), with 29% reporting graduate degree (M = 2.5, SD = 1.22), 14% reported an annual income of $50—59,000 (SD= 1.26), and 89.6% had health insurance. 

Results:  Hierarchical regression analyses demonstrate that comparative risk susceptibility (b = .194, p = .017) contributes to the SPM of African-American women while after assessing the contribution of risk susceptibility and severity, benefits, barriers, and subjective norms entered in the second block explain a 38.7% (p < .001) of variance in self-protective motivations controlling for comparative susceptibility and severity. Barriers (b = -.337, p < .001) and subjective norms (b = .205, p < .001) make a significant contribution while benefits did not contribute (b = -.002, p= .941). 

Conclusions:  African-American women assess their risk in comparative terms, perhaps in relation to others in their church group.  A significant contribution of severity was not detected, perhaps due to lack of variance in the sample. Subjective norms and barriers are significant issues African-American church-going women, perhaps due to the close nature of church congregations.

Implications for research and/or practice:  Public health officials can emphasize comparative risk susceptibility to include recommendations of family and friends that address barriers in reaching African-American women through church-based interventions. As a high proportion of the sample had health insurance, barriers should focus on convenience factors such as time, distance, and ease of obtaining a mammogram.