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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: a cross-sectional survey
Author(s): Marmara, Danika
Marmara, Vincent
Hubbard, Gill
Keywords: Breast cancer screening
Health belief model
Common-sense model
Issue Date: 8-May-2017
Citation: Marmara D, Marmara V & Hubbard G (2017) Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: a cross-sectional survey, BMC Public Health, 17, Art. No.: 416.
Abstract: Background  Women’s beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. This study utilized the health belief model (HBM) and common-sense model (CSM) of illness self-regulation to explore factors associated with BS uptake in Malta and subsequently, to identify the most important predictors to first screening uptake.  Methods  This cross-sectional survey enrolled Maltese women (n=404) ages 50 to 60 at the time of their first screening invitation, invited to the National Breast Screening Programme by stratified random sampling, with no personal history of BC. Participants responded to a 121-item questionnaire by telephone between June–September 2015. Data were analyzed using descriptive statistics, chi-square tests and logistic regression.  Results  There is high awareness of BC signs and symptoms among Maltese women (>80% agreement for 7 out of 8 signs), but wide variation about causation (e.g., germ or virus: 38.6% ‘agree’, 30.7% ‘disagree’). ‘Fear’ was the key reason for non-attendance to first invitation (41%,n=66) and was statistically significant across all subscale items (p<0.05). Most items within HBM constructs (perceived barriers; cues to action; self-efficacy) were significantly associated with first invitation to the National Breast Screening Programme, such as fear of result (χ2=12.0,p=0.017) and life problems were considered greater than getting mammography (χ2=38.8,p=0.000). Items within CSM constructs of Illness Representation (BC causes; cyclical cancer timeline; consequences) were also significantly associated, such as BC was considered to be life-changing (χ2=18.0,p=0.000) with serious financial consequences (χ2=13.3,p=0.004). There were no significant associations for socio-demographic or health status variables with uptake, except for family income (χ2=9.7,p=0.047). Logistic regression analyses showed that HBM constructs, in particular perceived barriers, were the strongest predictors of non-attendance to first invitation throughout the analyses (p<0.05). However, the inclusion of illness representation dimensions improved the model accuracy to predict non-attendance when compared to HBM alone (65% vs 38.8%).  Conclusions  Interventions should be based on theory including HBM and CSM constructs, and should target first BS uptake and specific barriers to reduce disparities and increase BS uptake in Malta.
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Rights: © The Author(s). 2017 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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