MAMMOGRAPHY BEHAVIORS IN MULTIPLE SCLEROSISMammography Screening Behaviors in Relation to the Expanded Health Belief Model in a Sample of Homebound Women with Multiple SclerosisKaren K. Paraska, PhD, RNUniversity of Pittsburgh, 2005The purpose of this study was to determine the relationship between variables of the Expanded Health Belief Model (EHBM) including: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy, and modifying factors; and adherence to mammography screening in homebound women with Multiple Sclerosis (MS). The sample was derived from the National Multiple Sclerosis Society from a group of women in Allegheny County who received an intervention program titled "Home-based Health Maintenance Program for Women with MS." The program provided home visits by a nurse midwife who educated women with MS and their partners about breast cancer, as well as provided an appointment for a mammogram.The correlational, descriptive design used a telephone interview for data collection. Due to the lack of subject accrual, the study was subsequently divided into two phases. Phase One was an analysis of 149 women who were approached to complete the intervention program through de-identified data sent by the National Multiple Sclerosis Society (NMSS). Phase Two was the dissertation study of homebound women consisting of a telephone interview measuring EHBM variables with the instruments chosen. The battery included the Breast Cancer Knowledge Test, the Benefits and Barriers Mammography Scale, Short Form-36, Beck Depression Inventory-II edition, Mini-Mental State Examination, the Mammography Screening Self-Efficacy Scale, and physician recommendation for mammogram.The de-identified data in Phase One revealed that out of 149 women approached, 108 women received the intervention program. None of these women had a mammogram in the last year. Only 7 (6%) women had a mammogram, none were diagnosed with breast cancer, and no correlation was found between smoking and mammography screening adherence. In Phase Two, out of all the EHBM variables analyzed, the data suggests bivariate association between perceived susceptibility, severity, benefits, and self-efficacy with mammography screening adherence. Due to the small sample size and sparse cell sizes, binary logistic regression was not able to investigate the joint associations of EHBM predictors. Mammography is the primary method used for breast cancer screening, yet in the sample of women with MS, adherence remains well below recommended levels. Women who did not adhere tended not to participate in the health care system, perceived themselves less susceptible to breast cancer, and valued mammography less. It was also evident that physician referral was not important in this study. The study had several limitations including a small sample size, the minimal data obtained from the NMSS, and the short study duration. Future recommendations include a longitudinal study design, incorporation of family caregivers, and an increase in recruitment strategies
