Theory of planned behavior and health disparities: Can models of individual-level processes be extended to complex multi-level phenomena?

Background: The Theory of Planned Behavior (TPB) attempts to describe influences of cognitive-affective processes on behavior. It is unclear whether it can help us understand complex phenomena, such as health disparities, that are shaped by multiple levels of social organization (e.g., individual, relational, societal). Purpose: We examined whether TPB constructs help explain why cancer information seeking is relatively less common among Hispanics. Methods: Employing a sample of Hispanics and Non-Hispanic White respondents (N =4922) from the nationally representative 2003 Health Information Trends Survey, we examined cancer information seeking behavior and intentions as a function of attitudes toward health care providers (HCPs) and contextual constraints including language preference and availability of usual source of care, adjusting for gender, age, education, personal and family history of cancer, and HCP visit frequency. Results: Compared to Whites, Hispanics were: 1)about a third less likely to have sought cancer information; 2)among respondents who had sought cancer information, they were more likely to have first sought information from an HCP than another source; 3)and were twice as likely to intend to seek cancer information from an HCP as from another source. Results are surprising given that Hispanics had more negative attitudes toward HCPs than Whites. Instead, differences in information seeking were accounted for by language preference. Conclusion: Relatively lower rates of cancer information seeking among Hispanics is a potential barrier to cancer prevention, screening and care. The TPB applies, but in the context of health disparities, constraints may overwhelm cognitions as predictors of health behavior.