Determinants of self-reported sustained breast cancer screening among women in Shenzhen, China: a study based on the health belief model
- 1Shenzhen Maternity and Child Healthcare Hospital, Women and Children’s Medical Center, Southern Medical University , , ,
Abstract
Background: Breast cancer is the most commonly diagnosed cancer among women worldwide. In Shenzhen, breast cancer screening is available through both a government-funded free program and a range of out-of-pocket or employer-sponsored options; however, evidence on factors associated with sustained screening remains limited. This study aimed to examine the direct and indirect associations of sociodemographic and health-related characteristics and health belief model (HBM) constructs with self-reported sustained breast cancer screening among women in Shenzhen, China.
Methods: A cross-sectional survey was conducted in Shenzhen, China, from November to December 2024, using multi-stage cluster sampling. Data on sociodemographic characteristics, health-related factors, and HBM constructs (five-point Likert scale) were collected. A structural equation model (SEM) was constructed to examine direct and indirect pathways linking sociodemographic characteristics, health-related factors, and HBM constructs to self-reported sustained breast cancer screening. Model fit was assessed using chi-square statistic divided by degrees of freedom (χ ² / df ), comparative fit index (CFI), Tucker–Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR).
Results: A total of 1,665 women were analyzed; 70.2% (1,169/1,665) had self-reported sustained breast cancer screening. The SEM showed good fit ( χ 2 / df =3.635; CFI = 0.960; TLI = 0.924; RMSEA = 0.040, SRMR = 0.022). Among the six HBM constructs, cues to action ( β standardized = 0.106, p = 0.013) were positively associated with self-reported sustained breast cancer screening, whereas perceived barriers ( β standardized = −0.165, p < 0.001) were negatively associated with this outcome. Additionally, age ( β standardized = −0.010, p = 0.029), educational level ( β standardized = 0.020, p < 0.001), average monthly income per household ( β standardized = 0.016, p = 0.002), and history of breast diseases ( β standardized = 0.011, p = 0.011) were indirectly associated with self-reported sustained breast cancer screening through perceived barriers. Moreover, history of breast diseases ( β standardized = 0.013, p = 0.028) was additionally indirectly associated with self-reported sustained breast cancer screening through cues to action. Furthermore, age ( β standardized = −0.003, p = 0.045), marital status ( β standardized = 0.003, p = 0.019) and history of breast diseases ( β standardized = 0.005, p < 0.001) were indirectly associated with self-reported sustained breast cancer screening through the sequential pathway involving cues to action and perceived barriers.
Conclusion: Cues to action and perceived barriers were key factors associated with self-reported sustained breast cancer screening. Targeted interventions that strengthen cues to action and reduce perceived barriers may help promote sustained breast cancer screening.
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BibTeX
@article{jin2026determinants,
title = {{Determinants of self-reported sustained breast cancer screening among women in Shenzhen, China: a study based on the health belief model}},
author = {Shuyan Jin and Xiaofeng Ma and Xueyu Yang and Wenxia Zhang and Huan Li and Yuqin Gu and Bo Wu},
journal = {Frontiers in public health},
year = {2026},
month = sep,
doi = {10.3389/fpubh.2026.1936136},
url = {https://europepmc.org/article/PMC/PMC13662284},
note = {CC BY},
}
RIS
TY - JOUR
TI - Determinants of self-reported sustained breast cancer screening among women in Shenzhen, China: a study based on the health belief model
AU - Shuyan Jin
AU - Xiaofeng Ma
AU - Xueyu Yang
AU - Wenxia Zhang
AU - Huan Li
AU - Yuqin Gu
AU - Bo Wu
PY - 2026
DA - 2026/09/30
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1936136
UR - https://europepmc.org/article/PMC/PMC13662284
AB - Background: Breast cancer is the most commonly diagnosed cancer among women worldwide. In Shenzhen, breast cancer screening is available through both a government-funded free program and a range of out-of-pocket or employer-sponsored options; however, evidence on factors associated with sustained screening remains limited. This study aimed to examine the direct and indirect associations of sociodemographic and health-related characteristics and health belief model (HBM) constructs with self-reported sustained breast cancer screening among women in Shenzhen, China. Methods: A cross-sectional survey was conducted in Shenzhen, China, from November to December 2024, using multi-stage cluster sampling. Data on sociodemographic characteristics, health-related factors, and HBM constructs (five-point Likert scale) were collected. A structural equation model (SEM) was constructed to examine direct and indirect pathways linking sociodemographic characteristics, health-related factors, and HBM constructs to self-reported sustained breast cancer screening. Model fit was assessed using chi-square statistic divided by degrees of freedom (χ ² / df ), comparative fit index (CFI), Tucker–Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). Results: A total of 1,665 women were analyzed; 70.2% (1,169/1,665) had self-reported sustained breast cancer screening. The SEM showed good fit ( χ 2 / df =3.635; CFI = 0.960; TLI = 0.924; RMSEA = 0.040, SRMR = 0.022). Among the six HBM constructs, cues to action ( β standardized = 0.106, p = 0.013) were positively associated with self-reported sustained breast cancer screening, whereas perceived barriers ( β standardized = −0.165, p < 0.001) were negatively associated with this outcome. Additionally, age ( β standardized = −0.010, p = 0.029), educational level ( β standardized = 0.020, p < 0.001), average monthly income per household ( β standardized = 0.016, p = 0.002), and history of breast diseases ( β standardized = 0.011, p = 0.011) were indirectly associated with self-reported sustained breast cancer screening through perceived barriers. Moreover, history of breast diseases ( β standardized = 0.013, p = 0.028) was additionally indirectly associated with self-reported sustained breast cancer screening through cues to action. Furthermore, age ( β standardized = −0.003, p = 0.045), marital status ( β standardized = 0.003, p = 0.019) and history of breast diseases ( β standardized = 0.005, p < 0.001) were indirectly associated with self-reported sustained breast cancer screening through the sequential pathway involving cues to action and perceived barriers. Conclusion: Cues to action and perceived barriers were key factors associated with self-reported sustained breast cancer screening. Targeted interventions that strengthen cues to action and reduce perceived barriers may help promote sustained breast cancer screening.
SN - 2296-2565
ER -