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A Structural Equation Modeling of Prostate Cancer Screening Intention

Article information

Res Community Public Health Nurs. 2019;30(4):471-483
Publication date (electronic) : 2019 December 12
doi : https://doi.org/10.12799/jkachn.2019.30.4.471
Ji Hye Jeong1, Nam Hee Park,2
1Visiting Professor, Department of Nursing, College of Koje, Geoje, Korea
2Associate Professor, Department of Nursing, Inje University, Busan, Korea
Corresponding author: Park, Nam Hee Department of Nursing, Inje University, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. Tel: +82-51-890-6832, Fax: +82-51-896-9840, E-mail: parknh@inje.ac.kr
Received 2019 July 08; Revised 2019 October 29; Accepted 2019 November 07.

Abstract

Abstract

Purpose

The purpose of this study was to identify factors associated with the intention of the prostate cancer screening (PCS). To achieve this purpose, a structural equation model was established based on the health belief model and the theory of planned behavior.

Methods

The subjects of this study were 260 male participants who were between 40 and 74 years old and had not taken the PCS. Data were collected using a structured self-report questionnaire (i.e., perceived benefits, perceived barriers, attitude, subjective norms, perceived behavior control, and intention of the PCS). Descriptive statistics, reliability analysis, correlation analysis, confirmatory factor analysis, and fitness test were used to test hypotheses.

Results

The intention of the PCS was directly affected by the perceived behavior control and indirectly influenced by the perceived benefits. The structural equation model also showed that the perceived behavior control explained 78% of the intention.

Conclusion

To raise the intention to take the PCS, it is necessary to increase the confidence of a subject that may control its difficulties and inform the perceived benefits of the PCS to a subject.

Keywords: Prostatic neoplasms; Early detection of cancer; Intention; Attitude
Figure 1.

Path diagram for the modified model.

General Characteristics of the Subjects (N=260)

Descriptive Statistics of the Main Variables (N=260)

Confirmatory Factor Analysis and Correlation Matrix (between measure variables) (N=260)

Effects of Predictor Variables on Endogenous Variables for Modified Model (N=260)

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Article information Continued

Copyright © 2019 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1.

Figure 1.

Path diagram for the modified model.

Table 1.

General Characteristics of the Subjects (N=260)

Characteristics Categories n (%) or M±SD
Age (year) 　 54.58±9.47
40~49 93 (35.8)
50~59 74 (28.5)
60~69 74 (28.5)
≥70 19 (7.3)
Marital state Single 19 (7.3)
Married 229 (88.1)
Others 12 (4.6)
Living arrangement Alone 34 (13.1)
Living with family 226 (86.9)
Education level ≤Middle school 30 (11.5)
High school 164 (63.1)
≥College 66 (25.4)
Monthly income ≤199 56 (21.5)
(10,000 won) ≥200 204 (78.5)
Have a close friend recommended you the test? No 229 (88.1)
Yes 31 (11.9)
Have your family doctor recommended you the test? No 243 (93.5)
Yes 16 (6.5)
Prostate cancer history of No 252 (96.9)
family Yes 8 (3.1)
Health education for prostate cancer No 242 (93.1)
Yes 18 (6.9)
Perceived health status Poor 13 (5.0)
Moderate 176 (67.7)
Good 71 (27.3)

Table 2.

Descriptive Statistics of the Main Variables (N=260)

Variables M±SD Range Skewness Kurtosis
Perceived benefit 3.94±0.54 1~5 -0.62 2.92
   Benefit 1 4.13±0.77 1~5 -1.01 2.19
   Benefit 2 3.48±1.03 1~5 -0.54 -0.59
   Benefit 3 4.12±0.77 1~5 -1.03 1.96
   Benefit 4 4.05±0.70 1~5 -0.94 2.56
   Benefit 5 3.80±0.82 1~5 -0.74 0.70
   Benefit 6 4.08±0.63 1~5 -0.53 1.83
Perceived barrier 3.11±0.52 1~5 -0.20 0.66
   Barrier 1 3.36±0.97 1~5 -0.34 -0.41
   Barrier 2 3.36±1.02 1~5 -0.75 -0.35
   Barrier 3 3.15±0.84 1~5 -0.13 0.22
   Barrier 4 3.38±0.92 1~5 -0.62 -0.30
   Barrier 5 3.41±0.91 1~5 -0.69 0.28
   Barrier 6 3.71±0.87 1~5 -1.26 1.75
   Barrier 7 3.18±1.07 1~5 -0.42 -0.88
   Barrier 8 2.94±0.98 1~5 0.00 -0.84
   Barrier 9 2.45±0.98 1~5 0.79 0.06
   Barrier 10 3.26±1.02 1~5 -0.40 -0.46
   Barrier 11 2.98±0.99 1~5 -0.05 -0.69
   Barrier 12 2.85±0.88 1~5 0.09 0.06
   Barrier 13 2.46±0.88 1~5 0.29 -0.17
   Barrier 14 3.02±0.96 1~5 -0.03 -0.23
Attitude 3.77±0.72 1~5 -0.27 -0.15
   Attitude 1 3.79±0.96 1~5 -0.71 0.53
   Attitude 2 3.78±0.89 1~5 -0.28 -0.38
   Attitude 3 3.79±0.89 1~5 -0.20 -0.78
   Attitude 4 3.76±1.05 1~5 -0.58 -0.20
   Attitude 5 3.86±0.89 1~5 -0.43 -0.19
   Attitude 6 3.63±1.02 1~5 -0.36 -0.47
Subjective norm 3.30±0.91 1~5 -0.37 -0.28
   Subjective norm 1 3.29±1.08 1~5 -0.25 -0.68
   Subjective norm 2 3.15±1.02 1~5 -0.23 -0.74
   Subjective norm 3 3.45±0.94 1~5 -0.73 0.18
Perceived behavioral control 3.47±0.76 1~5 -0.62 0.89
   Perceived behavioral control 1 3.49±0.86 1~5 -0.72 0.38
   Perceived behavioral control 2 3.65±0.80 1~5 -0.94 1.36
   Perceived behavioral control 3 3.27±0.91 1~5 -0.27 -0.18
Intention 3.15±0.86 1~5 -0.27 -0.20
   Intention 1 3.15±0.90 1~5 -0.30 -0.39
   Intention 2 3.20±0.89 1~5 -0.24 -0.31
   Intention 3 3.12±0.91 1~5 -0.18 -0.26

Table 3.

Confirmatory Factor Analysis and Correlation Matrix (between measure variables) (N=260)

Latent factors 1
 2
 3
 4
 5
 6
 Factor loading SE CR AVE CR
r (p) r (p) r (p) r (p) r (p) r (p)
1. Perceived benefit of PCS 1 .54~.79 0.11~0.13 7.25~9.70 .62 .89
2. Perceived barrier of PCS .05 1 .43~.86 0.14~0.21 5.57~8.32 .41 .82
(.656) 　 　
3. Attitude of PCS .38 .12 1 .57~.82 0.12~0.14 7.88~10.36 .55 .86
(.005) (.135)
4. Subjective norm of PCS .32 .26 .41 1 .80~.91 0.05 18.45~15.46 .73 .89
(.006) (.007) (.007)
5. Perceived behavioral control of PCS .43 .16 .38 .74 1 .75~.87 0.06 13.92~17.28 .75 .90
(.004) (.116) (.007) (.004)
6. Intention of PCS .26 .21 .36 .68 .87 1 .90~.94 0.04 25.10~28.07 .88 .96　
(.008) (.024) (.011) (.005) (.004)

SE=standards error; CR=critical ratio; AVE=average variance extracted; CR=compositive construct reliability; PCS=prostate cancer screening.

Table 4.

Effects of Predictor Variables on Endogenous Variables for Modified Model (N=260)

Endogenous variables Exogenous variable Standardized estimate (β) CR p Direct effect
 Indirect effect
 Total effect
 SMC
β (p) β (p) β (p)
Intention of PCS Attitude .04 0.89 .372 .04 (.541) .04 (.541) .78
Subjective norm .06 0.75 .453 .06 (.593) .06 (.593)
Perceived behavioral control .83 9.94 ＜.001 .83 (.004) .83 (.004)
Perceived benefit .36 (.004) .36 (.004)
Perceived barrier .16 (.068) .16 (.068)
Attitude of PCS Perceived benefit .40 4.87 ＜.001 .40 (.005) .40 (.005) .17
Perceived barrier .12 1.70 .089 .12 (.111) .12 (.111)
Subjective norm of Perceived benefit .33 4.54 ＜.001 .33 (.006) .33 (.006) .17
PCS Perceived barrier .25 3.53 ＜.001 .25 (.005) .25 (.005)
Perceived behavioral Perceived benefit .39 5.25 ＜.001 .39 (.005) 　 .39 (.005) .18
control of PCS Perceived barrier .17 2.48 .013 .17 (.076) .17 (.076)

CR=critical ratio; SMC=squared multiple correlation; PCS=prostate cancer screening.