Psychosocial Correlates of Cancer Screening Adherence in a Community Sample of Appalachian Adults: An Application of the Health Belief Model

Background: In the U.S., cancer disproportionately affects residents of Appalachia. These disparities may be due to high rates of advanced-stage cancer at initial diagnosis due to non-engagement in preventive activities such as recommended cancer screening.

Methods: The Health Belief Model (HBM) guided this research. Random-digits-dialing procedures were used to survey a community sample of Appalachian Ohio adults. Respondents provided information on current screening behaviors for breast, cervical, colorectal, and prostate cancers, as well as sociodemographic data. In addition, nine questions were asked about respondents' beliefs about cancer and cancer screening. Factor analyses indicated that questions loaded on three HBM constructs: perceived susceptibility to cancer, perceived benefits of cancer screening, and perceived barriers to cancer screening.

Results: Only one-third (36%) of respondents had been screened for cancer as recommended. After controlling for age, gender, and education, greater perceived benefits of (OR=1.35, p<.05), and fewer perceived barriers to (OR=.74, p<.10), cancer screening were associated with an increased likelihood of having been adherent to all screening recommendations. A significant interaction between gender and perceived susceptibility to cancer was also observed (p<.05). Among non-susceptible respondents, women were 5.35 times more likely than men to be adherent to screening recommendations; the opposite was true among susceptible respondents, with men being 2.33 times more likely than women to meet all screening recommendations.

Conclusions: Interventions to increase rates of screening in this population should focus not only on mitigating financial and structural barriers (e.g., lack of health insurance), but should also address the psychosocial needs of Appalachians.