European Journal of Oncology Nursing
Volume 32, 2018, Pages 55-62

Decisional balance and self-efficacy mediate the association among provider advice, health literacy and cervical cancer screening (Article)

Kim K.* , Xue Q.-L. , Walton-Moss B. , Nolan M.T. , Han H.-R.
  • a Department of Community-Public Health, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, United States
  • b School of Medicine, Johns Hopkins University, 733 N Broadway, Baltimore, MD 21205, United States
  • c Department of Nursing, School of Social Work, University of Southern California, 1150 South Olive St. Suite T1100, Los Angeles, CA 90015, United States
  • d Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, United States
  • e Department of Community-Public Health, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, United States

Abstract

Purpose Health literacy has emerged as a potential determinant of cancer screening, yet limited literature has investigated the pathways which health literacy influences Pap tests among immigrant women who experience a higher incidence of cervical cancer. This study aimed to test a health literacy-focused sociocognitive model which proposes motivational (knowledge, decisional balance) and volitional (self-efficacy) factors mediating the association between health literacy and triennial Pap tests. Methods Using structural equation modeling, we conducted a secondary analysis of baseline data obtained from a randomized controlled trial to promote breast and cervical cancer screenings among 560 Korean American women 21–65 years of age. They were interviewed on demographics such as education and English proficiency, provider advice, health literacy, knowledge of cervical cancer, decisional balance for Pap tests, self-efficacy, and Pap test use. Results Higher health literacy predicted high level of knowledge and high decisional balance score, and greater self-efficacy and then only decisional balance and self-efficacy affected Pap tests. High level of knowledge predicted Pap tests through its impact on the decisional balance score. Receiving provider advice both directly and indirectly predicted Pap tests through high level of health literacy, high level of decisional balance and greater self-efficacy. Conclusions Findings from this study suggest possible pathways through which provider advice and health literacy affect Pap tests. Interventions targeting immigrant women with limited English proficiency should consider skill-based approaches such as health literacy training, promoting patient-provider communications and emphasizing decisional balance and self-efficacy as potentially sustainable ways of promoting Pap tests. © 2017

Author Keywords

immigrant women Pap test use Provider advice Psychosocial determinants Structural equation modeling Health literacy

Index Keywords

Vaginal Smears human middle aged early cancer diagnosis Aged Early Detection of Cancer Self Efficacy Humans migrant psychology Emigrants and Immigrants female self concept Health Knowledge, Attitudes, Practice adult Uterine Cervical Neoplasms Papanicolaou Test uterine cervix tumor health literacy attitude to health vagina smear
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85037655438&doi=10.1016%2fj.ejon.2017.12.001&partnerID=40&md5=a673b687e88abe4f654b7ffcf2f2753c
DOI: 10.1016/j.ejon.2017.12.001
ISSN: 14623889
Cited by: 2
Original Language: English