title: Factors affecting breast cancer screening behavior in Japan--assessment using the health belief model and conjoint analysis.
abstract: BACKGROUND
  Japanese women in their 40s or older have been encouraged to attend breast cancer screening. However, the breast cancer screening rate in Japan is not as high as in Europe and the United States. The aim of this study was to identify psychological and personal characteristics of women concerning their participation in breast cancer screening using the Health Belief Model (HBM). In addition, the attributes of screening more easily accepted by participants were analyzed by conjoint analysis.
  
  
  METHODS
  In this cross sectional study of 3,200 age 20-69 women, data were collected by an anonymous questionnaire. Questions were based on HBM and personal characteristics, and included attitudes on hypothetical screening attributes. Data of women aged 40-69 were analyzed by logistic regression and conjoint analysis to clarify the factors affecting their participation in breast cancer screening.
  
  
  RESULTS
  Among responses collected from 1,280 women of age 20-69, the replies of 993 women of age 40-69 were used in the analysis. Regarding the psychological characteristics based on HBM, the odds ratios were significantly higher in "importance of cancer screening" (95%CI: 1.21-2.47) and "benefits of cancer screening" (95%CI: 1.09-2.49), whereas the odds ratio was significantly lower in "barriers to participation before cancer screening" (95%CI: 0.27-0.51). Conjoint analysis revealed that the respondents, overall, preferred screening to be low cost and by female staff members. Furthermore, it was also clarified that attributes of screening dominant in decision-making were influenced by the employment status and the type of medical insurance of the women.
  
  
  CONCLUSIONS
  In order to increase participation in breast cancer screening, it is necessary to disseminate accurate knowledge on cancer screening and to reduce barriers to participation. In addition, the attributes of screening more easily accepted were inexpensive, provided by female staff, executed in a hospital and finished in a short time.
authors.affiliation: Department of Health Informatics, Graduate School of Biomedical and Health Sciences Hiroshima University, Hiroshima, Japan E-mail : tsunematsu@hiroshima-u.ac.jp.
authors.forename: Miwako
authors.initials: M
authors.lastname: Tsunematsu
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kawasaki
authors.forename: Yuko
authors.initials: Y
authors.lastname: Masuoka
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kakehashi
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology*; D003430:Cross-Sectional Studies; D003469:Culture; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D011795:Surveys and Questionnaires; D055815:Young Adult