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dc.contributor.authorMarmara, Danikaen_UK
dc.contributor.authorMarmara, Vincenten_UK
dc.contributor.authorHubbard, Gillen_UK
dc.description.abstractBackground  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.en_UK
dc.publisherBioMed Centralen_UK
dc.relationMarmara 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.
dc.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.en_UK
dc.subjectBreast cancer screeningen_UK
dc.subjectHealth belief modelen_UK
dc.subjectCommon-sense modelen_UK
dc.titleHealth beliefs, illness perceptions and determinants of breast screening uptake in Malta: a cross-sectional surveyen_UK
dc.typeJournal Articleen_UK
dc.citation.jtitleBMC Public Healthen_UK
dc.type.statusVoR - Version of Recorden_UK
dc.contributor.affiliationHealth Sciences Stirlingen_UK
dc.contributor.affiliationUniversity of Stirlingen_UK
dc.contributor.affiliationHealth Sciences Highlanden_UK
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles

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