Factors influencing voluntary premarital medical examination in Zhejiang province, China: a culturally-tailored health behavioral model analysis

BMC Public Health

Hengjin Dong¹  Tingzhong Yang²  Chi Zhou³  Lu Li²  Yaming Gu² 

[1]Institute of Public Health, Heidelberg University, Heidelberg 69120, Germany

[2]Institute of Social Medicine & Family Medicine, Zhejiang University, Hangzhou 310058, China

[3]School of Health management, Hangzhou Normal University, Hangzhou 310058, China

关键词: Marlowe-Crowne social desirability scale;    Structural equation modeling;    Multilevel analysis model;    Theory of reasoned action;    Health belief model;    Premarital medical examination;   

Others  :  1129071
DOI  :  10.1186/1471-2458-14-659

 received in 2013-03-09, accepted in 2014-06-23,  发布年份 2014

【 摘 要 】

Background

Premarital medical examination (PME) compliance rate has dropped drastically since it became voluntary in China in 2003. This study aimed to establish a prediction model to be a theoretic framework for analyzing factors affecting PME compliance in Zhejiang province, China.

Methods

A culturally-tailored health behavioral model combining the Health Behavioral Model (HBM) and the Theory of Reasoned Action (TRA) was established to analyze the data from a cross-sectional questionnaire survey (n = 2,572) using the intercept method at the county marriage registration office in 12 counties from Zhejiang in 2010. Participants were grouped by high (n = 1,795) and low (n = 777) social desirability responding tendency (SDRT) by Marlowe-Crowne Social Desirability Scale (MCSDS). A structural equation modeling (SEM) was conducted to evaluate behavioral determinants for their influences on PME compliance in both high and low SDRT groups.

Results

69.8% of the participants had high SDRT and tended to overly report benefits and underreport barriers, which may affect prediction accuracy on PME participation. In the low SDRT group, the prediction model showed the most influencing factor on PME compliance was behavioral intention, with standardized structural coefficients (SSCs) being 0.75 (P < 0.01), and the intention was positively determined by individual’s attitude toward PME (SSCs = 0.48, P < 0.01) and subjective norms (SSCs = 0.22, P < 0.01) and negatively determined by perceived threat (SSCs = -0.08, P = 0.028). Attitudes and subjective norms were more crucial predictors for PME compliance than perceived threat (SSCs = 0.36, 0.269, and -0.06, respectively). County environmental factors played a role in PME compliance while less influential than behavioral determinates (16% vs. 84% in across factor variance partition coefficient).

Conclusions

PME compliance might be influenced by demographic, behavioral, and social environmental factors. The verified prediction model was tested to be an effective theoretic framework for the prediction of factors affecting voluntary PME compliance. It also should be noted that internationally available behavioral theories and models need to be culturally tailored to adapt to particular populations. This study has provided new insights for establishing a theoretical model to understand health behaviors in China.

【 授权许可】

   
2014 Gu et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Alswaidi FM, O’Brien SJ: Premarital screening programmes for haemoglobinopathies, HIV and hepatitis viruses: review and factors affecting their success. J Med Screen 2009, 16(1):22-28.
• [2]Ganczak M: The impact of premarital HIV testing: a perspective from selected countries from the Arabian Peninsula. AIDS Care 2010, 22(11):1428-1433.
• [3]Al-Aama JY: Attitudes towards mandatory national premarital screening for hereditary hemolytic disorders. Health Policy 2010, 97(1):32-37.
• [4]Fallah MS, Samavat A, Zeinali S: Iranian national program for the prevention of thalassemia and prenatal diagnosis: mandatory premarital screening and legal medical abortion. Prenat Diagn 2009, 29(13):1285-1286.
• [5]Arulogun OS, Adefioye OA: Attitude towards mandatory pre-marital HIV testing among unmarried youths in Ibadan northwest local government area, Nigeria. Afr J Reprod Health 2010, 14(1):83-94.
• [6]Umar SA, Oche OM: Knowledge of HIV/AIDS and use of mandatory premarital HIV testing as a prerequisite for marriages among religious leaders in Sokoto, North Western Nigeria. Pan Afr Med J 2012, 11:27.
• [7]Al-Farsi OA, Al-Farsi YM, Gupta l, Ouhtit A, Al-Farsi KS, Al-Adawi S: A study on knowledge, attitude, and practice towards premarital carrier screening among adults attending primary healthcare centers in a region in Oman. BMC Public Health 2014, 17(14):380-386.
• [8]Tosun F, Bilgin A, Kizilok A: Five-year evaluation of premarital screening program for hemoglobinopathies in the province of Mersin, Turkey. Turk J Hematol 2006, 23:84-89.
• [9]See LC, Teng FL, Peng PI, Shen YM, Lo YJ: Implementation of premarital health examination (PHE): an importance-performance analysis from participants who took PHE in Taiwan. Open Fam Stud J 2010, 3:1-9.
• [10]Hesketh T: Getting married in China: pass the medical first. BMJ 2003, 326(7383):277-279.
• [11]Li DZ: Premarital screening for thalassemia in mainland China. Prenat Diagn 2009, 29(6):637-638.
• [12]Jin QD: Analysis of free premarital medical examination and countermeasures. Chin Primary Health Care 2009, 23(5):49-51.
• [13]Wu MH, Yan M, Su SQ: Qualitative study on status and demand of premarital care in Beijing. Matern Child Health Care China 2009, 24(11):1536-1538.
• [14]Noar SM, Zimmerman RS: Health behavior theory and cumulative knowledge regarding health behavior: Are we moving in the right direction? Health Educ Res 2005, 20:275-290.
• [15]Glanz K, Rimer BK, Viswanath K: Health Behavior and Health Education: Theory, Research, and Practice. 4th edition. San Francisco: Jossey-Bass; 2008.
• [16]Noar SM: A health educator’s guide to theories of health behavior. Int Q Community Health Educ 2005, 24(1):75-92.
• [17]Noar SM, Chabot M, Zimmerman RS: Applying health behavior theory to multiple behavior change: considerations and approaches. Prev Med 2008, 46(3):275-280.
• [18]Rosenstock IM: Historical origins of the health belief model. Health Educ Monogr 1974, 2:328.
• [19]Janz NK, Becker MH: The health belief model: a decade later. Health Educ Q 1984, 11(1):1-47.
• [20]Becker MH: The health belief model and personal health behavior. Health Educ Monogr 1974, 2:324-473.
• [21]Kirscht JP: The health belief model and illness behavior. Health Educ Monogr 1974, 2:2387-2408.
• [22]Sharma M, Romas JA: Theoretical Foundations of Health Education and Health Promotion. 2nd edition. Burlington: Jones & Bartlett Learning; 2010.
• [23]Godin G, Maticka-Tyndale E, Adrien A, Manson-Singer S, Willms D, Cappon P: Cross-cultural testing of three social cognitive theories: an application to condom use. J Appl Soc Psychol 1996, 26:1556-1587.
• [24]Cummings KM, Becker MH, Maile MC: Bringing the models together: an empirical approach to combining variables used to explain health actions. J Behav Med 1980, 3(2):123-145.
• [25]VanLandingham MJ, Suprasert S, Grandjean N, Sittitrai W: Two views of risky sexual practices among northern Thai males: the health belief model and the theory of reasoned action. J Health Soc Behav 1995, 36:195-212.
• [26]Poss JE: Developing a new model for cross-cultural research synthesizing the Health Belief Model and the Theory of Reasoned Action. Adv Nurs Sci 2001, 23(4):1-15.
• [27]Soskolne V: Beliefs, recommendations and intentions are important explanatory factors of mammography screening behavior among Muslim Arab women in Israel. Health Educ Res 2007, 22(5):665-676.
• [28]Weinstein ND: Misleading tests of health behavior theories. Ann Behav Med 2007, 33:1-10.
• [29]Painter JE, Borba CPC, Hynes M, Mays D, Glanz K: The Use of Theory in Health Behavior Research from 2000 to 2005 a systematic review. Ann Behav Med 2008, 35(3):358-362.
• [30]Adibi P, Hedayati S, Mohseni M: Attitudes towards premarital screening for hepatitis B virus infection in Iran. J Med Screen 2007, 14(1):43-45.
• [31]Wu MT, Ma YS, Liu HW, Liu WJ, Ma HC, Pan C: The analysis of motivation and attitude of premarital medical examinees. GaoXiongYiXueKeXueZaZhi 1990, 6:594-598.
• [32]Wu Z, Rou K, Xu C, Lou W, Detels R: Acceptability of HIV/AIDS counseling and testing among premarital couples in China. AIDS Educ Prev 2005, 17(1):12-21.
• [33]Li L, Gu YM, Zhou C, Zhou XD, Zheng WJ, Yang TZ: Influencing factors on the voluntary premarital medical examination among Chinese. Zhonghualiuxingbingxuezazhi 2011, 32(11):1105-1109.
• [34]Ballard B, Crino MD, Rubenfeld S: Social desirability response bias and the Marlowe Crowne social desirability scale. Psychol Rep 1988, 63(1):227-237.
• [35]Beretvas SN, Meyers JL, Leite WL: A reliability generalization study of the Marlowe-Crowne Social Desirability Scale. Educ Psychol Meas 2002, 62:570-588.
• [36]Crowne DP, Marlowe DA: New scale of social desirability independent of psychopathology. J Consult Psychol 1960, 24(4):349-354.
• [37]Reynolds WM: Development of reliable and valid short forms of the Marlowe-Crowne Social Desirability Scale. J Clin Psychol 1982, 38(1):119-125.
• [38]Tao P, Guoying D, Brody S: Preliminary study of a Chinese language short form of the Marlowe-Crowne Social Desirability Scale. Psychol Rep 2009, 105(3F):1039-1046.
• [39]Healy MJR: Multilevel Data and Their Analysis. In Multilevel Modelling of Health Statistics. Edited by Leyland AH, Gooldstein H. Chichester: John Wiley & Sons; 2001:1-26.
• [40]Yang M, Li XS: Multilevel Modeling for Applied Research in Medicine and Public Health. Beijing: Peking University Medical Press; 2007.
• [41]Hau KT, Wen ZL, Cheng ZJ: Structural Equation Model and its Applications. Beijing: Educational Science Publishing House; 2004.
• [42]Champion VL, Skinner CS: The Health Belief Model. In Health Behavior and Health Education: Theory, Research, and Practice. 4th edition. Edited by Glanz K, Rimer BK, Viswanath K. San Francisco: Jossey-Bass; 2008:45-63.
• [43]Hwang K: Face and favor: the Chinese power game. Am J Sociol 1987, 92(4):944-974.
• [44]Markus HR, Kitayama S: Culture and the self: implications for cognition, emotion, and motivation. Psychol Rev 1991, 98(2):224-253.
• [45]Norman P: Applying the Health Belief Model to the prediction of attendance at health checks in general practice. Br J Clin Psychol 1995, 34:461-470.
• [46]Wurtele SK, Roberts MC, Leeper JD: Health beliefs and intentions: predictors of return compliance in a tuberculosis detection drive. J Appl Soc Psychol 1982, 12:128-136.
• [47]Xinying S, Yan G, Wang S, Sun J: Predicting iron-fortified soy sauce consumption intention: application of the theory of planned behavior and health belief model. J Nutr Educ Behav 2006, 38:276-285.
• [48]Ahmad F, Cameron JI, Stewart DE: A theory-based model for predicting adherence to guidelines for screening mammography among women age 40 and older. Int J Canc Prev 2005, 2(3):169-179.
• [49]Bosompra K, Flynn BS, Ashikaga T, Rairikar CJ, Worden JK, Solomon LJ: Likelihood of undergoing genetic testing for cancer risk: a population-based study. Prev Med 2000, 30(2):155-166.
• [50]Sullivan KT, Pasch LA, Cornelius T, Cirigliano E: Predicting participation in premarital prevention programs: the health belief model and social norms. Fam Process 2004, 43(2):175-193.
• [51]Kraus SJ: Attitudes and the prediction of behavior: a meta-analysis of the empirical literature. Personal Soc Psychol Bull 1995, 21:58-75.
• [52]Trafimow D: Predicting intentions to use a condom form perceptions of normative pressure and confidence in those perceptions. J Appl Soc Psychol 1994, 24:2151-2163.
• [53]Trafimow D, Finlay KA: The importance of subjective norms for a minority of people: between-subjects and within-subjects analyses. Personal Soc Psychol Bull 1996, 22:820-828.
• [54]Finlay KA, Trafimow D, Jones D: Predicting health behaviors from attitudes and subjective norms: between-subjects and within subjects analysis. J Appl Soc Psychol 1997, 27:2015-2031.
• [55]King J: The impact of patients’ perceptions of high blood pressure on attendance at screening. Soc Sci Med 1982, 16:1079-1091.
• [56]Calnan M: The health belief model and participation in programmes for the early detection of breast cancer: A comparative analysis. Soc Sci Med 1984, 19:823-830.
• [57]Fukuda Y, Nakamura K, Takano T: Reduced likelihood of cancer screening among women in urban areas and with low socio-economic status: a multilevel analysis in Japan. Public Health 2005, 119(10):875-884.
• [58]Lian M, Schootman M, Yun S: Geographic variation and effect of area-level poverty rate on colorectal cancer screening. BMC Public Health 2008, 8:358.
• [59]Li D, Hyde A, Zeng Y: Impacts of social desirability response bias on sexuality care of cancer patients among Chinese nurses. Open J Nurs 2012, 2:341-345.
• [60]LiF NXY, Li YJ: Age-related and situation-related social desirability responding among Chinese teachers. J Soc Psychol 2011, 151(6):667-670.
• [61]Li F, Li YJ: The balanced inventory of desirable responding (BIDR): a factor analysis. Psychol Rep 2008, 103:727-731.
• [62]Uskul AK, Oyserman D: Question Comprehension and Response: Implications of Individualism and Collectivism. In National Culture and Groups (Research on Managing Groups and Teams, Volume 9). Edited by Chen YR. Bingley: Emerald Group Publishing Limited; 2006:173-201.