A structural model of the role of causal attributions and health beliefs in determining breast cancer early detection behaviors

The present study developed and tested a structural (LISREL) model of breast cancer early detection behaviors, which incorporated the Health Belief Model, the attribution theories of Kelley and Weiner, and women's perceptions of how important their breasts are in determining their feelings of femininity and and sexuality. The subjects were 402 women from a small town in Ohio. The model testing procedures were first performed on a subsample of 268 subjects, and later successfully cross-validated on the remaining 134 subjects. The health belief variables included in the model were perceived threat of developing breast cancer, perceived benefits of early detection, and barriers that may prevent women from engaging in early detection behaviors. Bandura's construct of self- efficacy, and embarrassment concerning touching or talking about one's breasts formed the barriers construct. Elements from Kelley's and Weiner's theories were conceptualized in terms of health attributions. Perceived commonness of breast cancer represented Kelley's dimension of consensus, and perceived multiplicity of causes represented the dimension of distinctiveness. Weiner's three dimensions of internality, stability and controllability were applied separately to the factors that cause breast cancer and factors that influence it's progress once it has been diagnosed. Behavioral intentions served as the major dependent variable. In the structural model that was tested, importance of breasts, Kelley's dimensions of consensus and distinctiveness, stability of cause and progress, internality of cause, and controllability of cause all had direct paths to perceived threat. Internality of progress, controllability of progress, and self-efficacy had direct paths to perceived benefits. Threat and benefits were not related to one another, but they both had direct paths to behavioral intentions. Self-efficacy, embarrassment, and all the attributional factors also had direct paths to intentions. To test the hypothesis that attributions would have only indirect effects on intentions, the above model was compared with a competing model in which attributions were not allowed direct paths to intentions, but could only affect them indirectly through threat and benefits. All the remaining paths were the same in the two models. [...]