To do or not to do? The role of body image and Theory of Planned Behaviour on the implementation of Breast Self-Examination

Journal title PSICOLOGIA DELLA SALUTE
Author/s Giulia Rosa Policardo, Cristian Di Gesto, Amanda Nerini, Camilla Matera
Publishing Year 2025 Issue 2025/1
Language Italian Pages 22 P. 13-34 File size 236 KB
DOI 10.3280/PDS2025-001004
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Breast-Self Examination (BSE) is an efficient and cost-effective breast cancer prevention strategy. BSE requires a meticulous examination of one’s breasts, so that women who are dissatisfied and uncomfortable with their bodies may perform this less frequently. On the other hand, when women develop a positive attitude towards their bodies, they tend to be more inclined to take care of their overall health by performing medical screening more frequently. Using the Theory of Planned Behaviour (TPB) as a framework, this study examines the role of various dimensions of body image (positive and negative), together with the components of TPB, in predicting BSE intentions and actual behaviour in Italian women. The initial sample (T1) of 409 women (M=30.31) decreased to 105 participants (M=31.45) at follow-up (T2). The questionnaire at T1 captured the variables associated with TPB and body image, while at T2 the actual behaviour was recorded. Path-analysis indicates that intentions are positively associated with behaviour, predicted by subjective norms and Perceived Behavioural Control (PBC). General body dissatisfaction appears to indirectly predict intentions (via PBC) whereas body-compassion and breast dissatisfaction are directly associated with behaviour. These findings emphasise the importance of structuring breast cancer prevention campaigns that include interventions aimed at improving body image, from a compassionate perspective, and that emphasise the role of significant others and the perceived ease and cost-effectiveness of performing the BSE to increase behavioural intention and, consequently, behaviour implementation.

Keywords: Breast Self-Examination, body image, health prevention, Theory of Planned Behaviour, correlational study, women

  1. Wheaton B., Muthen B., Alwin D.F. and Summers G.F. (1977). Assessing reliability and stability in panel models. Sociological Methodology, 8: 84-136. DOI: 10.2307/27075
  2. Ahmadian M., Carmack S., Samah A.A., Kreps G. and Saidu M.B. (2016). Psychosocial predictors of breast self-examination among female students in Malaysia: A study to assess the roles of body image, self-efficacy and perceived barriers. Asian Pacific Journal of Cancer Prevention, 17(3): 1277-1284. DOI: 10.7314/APJCP.2016.17.3.127
  3. Ajzen I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2): 179-211. DOI: 10.1016/0749-5978(91)90020-
  4. Ajzen I. (2002). Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. Journal of Applied Social Psychology, 32(4): 665-683.
  5. Ajzen I. (2006). Constructing a Theory of Planned Behavior Questionnaire. -- Retrieved from: https://people.umass.edu/~aizen/pdf/tpb.measurement.pdf
  6. Altman J.K., Linfield K., Salmon P.G. and Beacham A.O. (2017). The Body Compassion Scale: Development and initial validation. Journal of Health Psychology, 25(4): 439-449. DOI: 10.1177/135910531771892
  7. Andrew R., Tiggemann M. and Clark L. (2016). Positive body image and young women’s health: Implications for sun protection, cancer screening, weight loss and alcohol consumption behaviours. Journal of Health Psychology, 21(1): 28-39. DOI: 10.1177/135910531452081
  8. Arcarisi L., Di Pietro L., Carbonaro N., Tognetti A., Ahluwalia A. and De Maria C. (2019). Palpreast—a new wearable device for breast self-examination. Applied Sciences, 9(3): 381- 392.
  9. Associazione Italiana per la Ricerca sul Cancro (2020). -- Retrieved from: https: //www.airc.it/news/2000-2020-i-principali-risultati-e-successi-contro-il-cancro-dal-2015-in-avanti
  10. Associazione Italiana Registro Tumori (2020). I tumori in Italia – Rapporto AIRTUM 2020. -- Retrieved from: https: //www.registri-tumori.it/cms/sites/default/files/pubblicazioni/new_NDC2020- operatori-web.pdf.
  11. Watson L.B., Lewis J.A. and Moody A.T. (2019). A sociocultural examination of body image among Black women. Body Image, 31: 280-287.
  12. Banerjee S. and Ho S.S. (2020). Applying the theory of planned behavior: Examining how communication, attitudes, social norms, and perceived behavioral control relate to healthy lifestyle intention in Singapore. International Journal of Healthcare Management, 13(1): 496-503. DOI: 10.1080/20479700.2019.160568
  13. Beadle E.S. (2020). Body shame, body compassion and physical activity. Doctoral Dissertation. University of Hertfordshire.
  14. Becker A.E. (2018). Sociocultural influences on body image and eating disturbance. In Eating Disorders and Obesity: A Comprehensive Handbook. New York: Guilford Press, pp. 127-133.
  15. Casale S., Prostamo A., Giovannetti S. and Fioravanti G. (2021). Translation and validation of an Italian version of the Body Appreciation Scale-2. Body Image, 37: 1-5.
  16. Chait S.R., Thompson J.K. e Jacobsen P.B. (2009). Relationship of body image to breast and skin self-examination intentions and behaviors. Body Image, 6(1): 60-63.
  17. Chouliara Z., Miller M., Stott D., Molassiotis A., Twelves C. and Kearney N. (2004). Older people with cancer: perceptions and feelings about information, decision-making and treatment—a pilot study. European Journal of Oncology Nursing, 8(3): 257-261.
  18. Clark M.A., Rogers M.L., Armstrong G.F., Rakowski W., Bowen D.J., Hughes T. and McGarry K.A. (2009). Comprehensive cancer screening among unmarried women aged 40–75 years: Results from the cancer screening project for women. Journal of Women’s Health, 18(4): 451-459.
  19. Dowson J. and Henderson L. (2001). The validity of a short version of the Body Shape Questionnaire. Psychiatry Research, 102(3): 263-271. DOI: 10.1016/S0165-1781(01)00254-
  20. Elmore J.G., Armstrong K., Lehman C.D. and Fletcher S.W. (2005). Screening for Breast Cancer. JAMA, 293(10): 1245-1256.
  21. Haug E., Castillo I., Samdal O. and Smith O.R.F. (2023). Body-related concerns and participation in physical education among adolescent students: the mediating role of motivation. Frontiers in Psychology, 14: 1266740.
  22. Hooper D., Coughlan J. and Mullen M.R. (2008). Structural Equation Modelling: Guidelines for Determining Model Fit. The Electronic Journal of Business Research Methods, 6: 53-60. DOI: 10.21427/D7CF7
  23. Hu L.T. and Bentler P.M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1): 1-55. DOI: 10.1080/1070551990954011
  24. IBM Corporation (2016). IBM SPSS Statistics for Windows (Version 24.0) [Computer software]. IBM Corporation.
  25. Malvezzi M., Carioli G., Bertuccio P., Boffetta P., Levi F., La Vecchia C. and Negri E. (2019). European cancer mortality predictions for the year 2019 with focus on breast cancer. Annals of Oncology, 30(5): 781-787.
  26. Mason T.E. and White K.M. (2008). Applying an extended model of the theory of planned behaviour to breast self-examination. Journal of Health Psychology, 13(7): 946-955. DOI: 10.1177/135910530809506
  27. Matera C., Nerini A. and Stefanile C. (2013). Misurare l’insoddisfazione corporea: validazione della versione italiana del Body Shape Questionnaire-14 (BSQ-14) [Assessing body dissatisfaction: Validation of the Italian version of the Body Shape Questionnaire-14 (BSQ-14)]. Counseling: Giornale Italiano di Ricerca e Applicazioni, 6(2): 235-244.
  28. McEachan R.R.C., Conner M., Taylor N.J. and Lawton R.J. (2011). Prospective prediction of health-related behaviours with the theory of planned behaviour: A meta-analysis. Health Psychology Review, 5(2): 97-144. DOI: 10.1080/17437199.2010.52168
  29. Mendia J., Pascual A., Conejero S. and Mayordomo S. (2021). The relationship between body and appearance-related self-conscious emotions and disordered eating: The mediating role of symptoms of depression and anxiety. International Journal of Psychology and Psychological Therapy, 21(1): 93–105.
  30. Piko B.F., Obál A. and Mellor D. (2020). Body Appreciation in Light of Psychological, Health- and Weight-Related Variables Among Female Adolescents. Europe’s Journal of Psychology, 16(4): 676-687.
  31. Policardo G.R., Nerini A., Di Gesto C. and Matera C. (2022). Body compassion scale: A validation study in the Italian context. European Journal of Health Psychology, 29(2): 82-91.
  32. Preacher K.J. and Hayes A.F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3): 879-891.
  33. Ridolfi D.R. and Crowther J.H. (2013). The link between women’s body image disturbances and body-focused cancer screening behaviors: A critical review of the literature and a new integrated model for women. Body Image, 10(2): 149-162.
  34. Rincón Uribe F.A., Godinho R.C.D.S., Machado M.A.S., Oliveira K.R.D.S.G., Neira Espejo C.A., de Sousa N.C.V. ... and Pedroso J.D.S. (2021). Health knowledge, health behaviors and attitudes during pandemic emergencies: A systematic review. PloS One, 16(9), e0256731.
  35. Rucker D.D., Preacher K.J., Tormala Z.L. and Petty R.E. (2011). Mediation analysis in social psychology: Current practices and new recommendations. Social and Personality Psychology Compass, 5(6): 359-371.
  36. Samah A.A. and Ahmadian M. (2014). Relationship between body image and breast self- examination intentions and behaviors among female university students in Malaysia. Asian Pacific Journal of Cancer Prevention, 15(21): 9499-9503.
  37. Streiner D.L. (2005). Finding our way: an introduction to path analysis. The Canadian Journal of Psychiatry, 50(2): 115-122. DOI: 10.1177/07067437050500020
  38. Swami V. and Furnham A. (2018). Breast size dissatisfaction, but not body dissatisfaction, is associated with breast self-examination frequency and breast change detection in British women. Body Image, 24: 76-81.
  39. Swami V., Cavelti S., Taylor D. and Tovée M.J. (2015). The breast size rating scale: Development and psychometric evaluation. Body Image, 14: 29-38.
  40. Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., ... and (HLS-EU) Consortium Health Literacy Project European. (2012). Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health, 12: 1-13. DOI: 10.1186/1471-2458-12-8
  41. Tu S.P., Reisch L.M., Taplin S.H., Kreuter W., Elmore J.G. and Legge Muilenburg J. (2006). Breast self-examination: self-reported frequency, quality, and associated outcomes. Journal of Cancer Education, 21(3): 175-181.
  42. Tylka T.L. (2011). Positive psychology perspectives on body image. In Cash T.F. and Smolak L., eds., Body image: A handbook of science, practice, and prevention. New York: Guilford, pp. 56–64.
  43. Tylka T.L. (2018). Overview of the field of positive body image. In E.A. Daniels, M.M. Gillen and C.H. Markey, eds., Body positive: Understanding and improving body image in science and practice. Cambridge: Cambridge University Press, pp. 6-33.
  44. Tylka T.L. and Wood-Barcalow N.L. (2015). What is and what is not positive body image? Conceptual foundations and construct definition. Body Image, 14: 118-129.
  45. Wang J. and Wang X. (2012). Structural Equation Modeling: Applications Using Mplus. Hoboken, NJ: Wiley Higher Education Press.
  46. Zanon A., Tomassoni R., Gargano M. and Granai M.G. (2016). Body image and health behaviors: is there a relationship between lifestyles and positive body image. La Clinica Terapeutica, 167(3): 63-69. DOI: 10.7417/CT.2016.193

Giulia Rosa Policardo, Cristian Di Gesto, Amanda Nerini, Camilla Matera, To do or not to do? Il ruolo dell’immagine corporea e della Teoria del Comportamento Pianificato sull’attuazione dell’autoesame al seno in "PSICOLOGIA DELLA SALUTE" 1/2025, pp 13-34, DOI: 10.3280/PDS2025-001004