Factors Affecting Breast Cancer Screening Behavior in Japan - Assessment using the Health Belief Model and Conjoint Analysis

Background: Japanese women in their 40s or older have been encouraged to attend breast cancer screening.However, the breast cancer screening rate in Japan is not as high as in Europe and the United States. The aimof this study was to identify psychological and personal characteristics of women concerning their participationin breast cancer screening using the Health Belief Model (HBM). In addition, the attributes of screening moreeasily accepted by participants were analyzed by conjoint analysis. Materials and
Methods: In this cross sectionalstudy of 3,200 age 20-69 women, data were collected by an anonymous questionnaire. Questions were basedon HBM and personal characteristics, and included attitudes on hypothetical screening attributes. Data ofwomen aged 40-69 were analyzed by logistic regression and conjoint analysis to clarify the factors affecting theirparticipation in breast cancer screening.
Results: Among responses collected from 1,280 women of age 20-69, thereplies of 993 women of age 40-69 were used in the analysis. Regarding the psychological characteristics basedon HBM, the odds ratios were significantly higher in “importance of cancer screening” (95%CI: 1.21-2.47) and“benefits of cancer screening” (95%CI: 1.09-2.49), whereas the odds ratio was significantly lower in “barriersto participation before cancer screening” (95%CI: 0.27-0.51). Conjoint analysis revealed that the respondents,overall, preferred screening to be low cost and by female staff members. Furthermore, it was also clarified thatattributes of screening dominant in decision-making were influenced by the employment status and the type ofmedical insurance of the women.
Conclusions: In order to increase participation in breast cancer screening, itis necessary to disseminate accurate knowledge on cancer screening and to reduce barriers to participation. Inaddition, the attributes of screening more easily accepted were inexpensive, provided by female staff, executedin a hospital and finished in a short time.