A Theory-Based Model for Predicting Adherence to Guidelines for Screening Mammography among Women Age 40 and Older

OBJECTIVE: To examine theory-based selected factors associated with adherence to mammography screening guidelines in a surveillance database. METHODS: Data from Colorado Mammography Project (CMAP) from 1994-1998 was extracted and analyzed by using SAS statistical software. Based on the Health Belief Model and Behavioral Model of Health Services Utilization a prediction model was developed to examine the mammography utilization patterns and factors influencing the adherence to screening guidelines. RESULTS: Out of 27,778 women, 41.4% were adherent with mammography screening guidelines. According to the model tested in this study, race/ethnicity (Black vs White, OR=0.76, 95% CI=0.64-0.91); educational attainment (high school vs < high school, OR= 1.10, 95% CI= 1.04-1.18), college graduate vs < high school (OR=1.33, 95% CI=1.25-1.42); insurance status, (any coverage vs no coverage (OR=1.62, 95% CI=1.25-2.12); and community economic status as defined by median income by zip code of residence ($15,000-$24,999 vs <$15,000, OR=0.84, 95% CI=0.76-0.94; >$55,000 vs <$15,000, OR 1.14, 95% CI=1.03-1.26) were statistically significant predictors of adherence to guidelines. Interaction between age and family history of breast cancer was statically significant. Younger females with a family history of breast cancer were less likely to be adherent than their counterparts without a family history (OR=0.93, 95% CI=0.90-0.96). Inclusion or exclusion of women aged 70 years and older did not change the outcome of the analysis. CONCLUSION: The prediction model variables such as race/ethnicity, age and family history of breast cancer, educational level and community economic status, are associated with adherence status. Family history of breast cancer needs to be examined very carefully in future studies as it may play negative role in adherence to screening mammography.