Received 8/5/96; revised 2/5/97; accepted 2/6/97. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. I Supported by National Cancer Institute Grant R01-CA55917. 2 To whom requests for reprints should be addressed, at Center for Gerontology and Health Care Research, Box G-B 213, Brown University, Providence. RI 02912. Vol. 6, 451-457, June 1997 Cancer Epidemioloej , Biomarkers & Prevention 45/ 3 The abbreviations used are: ‘ITM, Transtheoretical Model; CBE, clinical breast examination. Why Do Women’s Attitudes toward Mammography Change over Time? Implications for Physician-Patient Communication’ Deborah N. Pearlman,2 William Rakowski, Melissa A. Clark, Beverly Ehrich, Barbara K. Rimer, Michael G. Goldstein, Hugh Woolverton Ill, and Catherine E. Dube Center for Gerontology and Health Care Research [D. N. P., W. R., M. A. C., B. E.], Departments of Community Health [D. N. P.. W. R., M. A. C.] and Psychiatry and Human Behavior [M. G. G.], and Center for Alcohol and Addiction Studies [C. E. Dl, Brown University, Providence, Rhode Island 02912; Comprehensive Cancer Center, Duke University, Durham, North Carolina 27710 [B. K. RI; Division of Behavioral and Preventive Medicine, Miriam Hospital, Providence, Rhode Island 02912 [M. G. G.]; and Harvard Pilgrim Health Care of New England, Swansea, Massachusetts 02774 [H. W.] Abstract The present study examines women’s decision making about mammography over a 1-year period, using “decisional balance,” a summary of women’s positive and negative perceptions about mammography derived from the Transtheoretical Model (TTM). Data were from a survey of women ages 50-74 years who completed both the baseline and 1-year follow-up telephone surveys (n = 1144) for an intervention study to increase the use of mammography screening. A shift toward less favorable perceptions about mammography was related to being a smoker and not having a recent clinical breast examination and Pap test. Change in women’s attitudes toward mammography was also related to four dimensions of a woman’s information environment. Women who rated the opinions of a physician as somewhat or not important, those who reported that at least one family member or friend discouraged them from having a mammogram, and women who felt they lacked enough people in their social network with whom they could discuss health concerns were less likely to express favorable attitudes about mammography over 1 year. In contrast, women who consistently communicated the value of mammography to others expressed more favorable views of screening over the study period. Interventions designed to promote breast cancer screening must recognize that a woman not only reacts to mammography information provided by significant others in her social network but may proactively reach out to others as an advocate of breast cancer screening, thus reinforcing or changing others’ opinions or behavior as well as her own. Introduction Increasing the proportion of women over age 50 who are screened routinely for breast cancer has been targeted as an important national priority (1). Because a physician’s recom- mendation is one of the strongest predictors of mammography use (2-8), primary care physicians are being encouraged to regularly counsel patients about early detection of cancer (9- 10). However, as many studies have demonstrated, there are important barriers to the delivery of preventive services by primary care providers, including the incorporation of cancer screening into routine office procedures (9-12). The gap between physicians’ knowledge and implemen- tation of cancer screening guidelines has stimulated interest in developing interventions to overcome obstacles in the delivery of preventive services. For example, physicians who have not had specific training in patient education and counseling skills may feel unprepared to counsel patients who are less motivated to pursue preventive care. A significant challenge for academic research is to give health care professionals guidance regarding information that is important to elicit from women in order to assess readiness and motivation for breast cancer screening and to determine how to effectively intervene with those who are reluctant. Strategies to help individuals change their health habits often yield mixed results, because health habits once learned are not easily altered (13). An increasing number of studies have shown that the 1TM’ provides a useful framework for understanding short- and long-term behavior change. To date, the TTM has been applied to a wide range of personal health behaviors, including smoking, weight control, and screening mammography (14), as well as compliance with multiple can- cer screening behaviors (15). The extension of the TTM to screening mammography has been described in detail else- where (16-19). An important finding from this research, rele- vant for clinical practice, is that a patient’s stage of readiness to adopt mammography can be determined with as few as two questions: (a) How often do you have mammograms? and (b) When are you planning to have your next mammogram? Stag- ing women according to both past behavior and future intention provides the minimum information necessary to identify women who are at risk of either not having an initial mammo- gram or lapsing from the recommended schedule (I 9). Assessing stage of adoption is a central feature of the TFM; it gives a provider a way to initially classify a woman’s readiness to obtain a mammogram. However, it is still neces- sary to know why a woman might modify her screening behav- ior. A second component of the ‘fl’M, decisional balance, denotes a person’s overall attitudes with respect to changing a health habit. Decisional balance is calculated by subtracting on January 12, 2022. © 1997 American Association for Cancer Research. cebp.aacrjournals.org Downloaded from