Determinants of Breast Cancer Screening Uptake Among Women in Northern Iran: A Cross-Sectional Analysis of Health Beliefs and Health Literacy.

BACKGROUND AND AIMS: Breast cancer is the most prevalent malignancy among women worldwide. Early detection through screening is crucial for reducing mortality. This study aimed to determine the association between Health Belief Model (HBM) constructs, health literacy, and breast cancer screening practices among women in Babol, Iran.

METHODS

This descriptive-analytical cross-sectional study was conducted on 320 women aged 20-65 visiting healthcare centers in Babol in 2024. Data were collected using standardized questionnaires, including demographic information, Champion's Health Belief Model Scale (CHBMS), Breast Fear Scale, and the Health Literacy for Iranian Adults (HELIA) questionnaire. Screening performance was assessed based on breast self-examination (BSE), clinical breast examination (CBE), and mammography (for women ≥ 40). Data analysis was performed using SPSS version 20, employing descriptive statistics, Chi-square tests, t-tests, and multivariable logistic regression.

RESULTS

The mean age of participants was 35.73 (± 7.74) years. The rates of BSE (137/320, 42.8%), CBE (124/320, 38.7%), and mammography (in women over 40: 38/104, 36.5%) were observed. Multivariable analysis revealed that performing BSE was significantly associated with higher scores of self-efficacy (OR = 1.15, 95% CI: 1.10-1.19, p < 0.001), positive attitude (OR = 1.10, 95% CI: 1.03-1.16, p < 0.001), and cues to action (OR = 1.06, 95% CI: 1.00-1.13, p = 0.046), while inversely associated with perceived barriers (OR = 0.96, 95% CI: 0.92-0.99, p = 0.048). For CBE, self-efficacy (OR = 1.15, 95% CI: 1.11-1.20, p < 0.001), fear of breast cancer (OR = 0.91, 95% CI: 0.87-0.95, p < 0.001), age (OR = 1.11, 95% CI: 1.05-1.17, p < 0.001), and attitude (OR = 1.07, 95% CI: 1.01-1.13, p = 0.01) were significant predictors. In women over 40, performing mammography was positively associated with self-efficacy (OR = 1.23, 95% CI: 1.09-1.39, p = 0.0012) and age (OR = 1.20, 95% CI: 1.07-1.35, p < 0.001).

CONCLUSION

Breast cancer screening rates were suboptimal. Self-efficacy was a strong, consistent predictor for all three screening methods (BSE, CBE, and mammography), while other psychological and demographic factors like attitude, fear, and age were uniquely associated with specific screening behaviors.