title: Can health beliefs help in explaining attendance to follow-up care? The Swiss childhood cancer survivor study.
abstract: OBJECTIVE
  Improved treatment has increased the survival of childhood cancer patients in recent decades, but follow-up care is recommended to detect and treat late effects. We investigated relationships between health beliefs and follow-up attendance in adult childhood cancer survivors.
  
  
  METHODS
  Childhood cancer survivors aged younger than 16 years when diagnosed between 1976 and 2003, who had survived for more than 5 years and were currently aged 20+ years, received a postal questionnaire. We asked survivors whether they attended follow-up in the past year. Concepts from the Health Belief Model (perceived susceptibility and severity of future late effects, potential benefits and barriers to follow-up, general health value and cues to action) were assessed. Medical information was extracted from the Swiss Childhood Cancer Registry.
  
  
  RESULTS
  Of 1075 survivors (response rate 72.3%), 250 (23.3%) still attended regular follow-up care. In unadjusted analyses, all health belief concepts were significantly associated with follow-up (p<0.05). Adjusting for other health beliefs, demographic, and medical variables, only barriers (OR=0.59; 95%CI: 0.43-0.82) remained significant. Younger survivors, those with lower educational background, diagnosed at an older age, treated with chemotherapy, radiotherapy, or bone marrow transplantation and with a relapse were more likely to attend follow-up care.
  
  
  CONCLUSIONS
  Our study showed that more survivors at high risk of cancer- and treatment-related late effects attend follow-up care in Switzerland. Patient-perceived barriers hinder attendance even after accounting for medical variables. Information about the potential effectiveness and value of follow-up needs to be available to increase the attendance among childhood cancer survivors.
authors.affiliation: Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland. michel@ispm.unibe.ch
authors.forename: Gisela
authors.initials: G
authors.lastname: Michel
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Kuehni
authors.forename: Cornelia E
authors.initials: CE
authors.lastname: Rebholz
authors.forename: Karin
authors.initials: K
authors.lastname: Zimmermann
authors.forename: Christine
authors.initials: C
authors.lastname: Eiser
authors.forename: Corina S
authors.initials: CS
authors.lastname: Rueegg
authors.forename: Nicolas X
authors.initials: NX
authors.lastname: von der Weid
mesh_terms: D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013557:Switzerland; D055815:Young Adult