The health belief model and theory of planned behavior applied to mammography screening: A systematic review and meta-analysis

Background The Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) are used to explain screening behavior. Although reviews of each model have been conducted independently, none have compared the application of both to mammography screening. Methods A systematic review of literature published in five databases from 1974 to 2020 was performed. Meta-analysis of the explanatory value of the HBM and TPB and effect sizes of their cognitive variables was conducted. Results Altogether, 673 papers reporting HBM studies and 577 reporting TPB studies were recovered, of which 43 HBM studies and 15 TPB studies met the eligibility criteria. Twelve studies reported on the explanatory value of either model. The explained variance for HBM ranged from 25% to 89% (mean R-2 = .55), while the explained variance for TPB ranged from 16% to 81% (mean R-2 = .24 [screening behavior as outcome] and 0.46 [intention as outcome]). The component of cue to action had the greatest effect size (mean OR 1.80 [95% CI: 1.58-2.04]). Conclusions While the HBM and TPB both demonstrated positive explanatory value, most studies examined the individual constructs of each model and failed to report consistently on the effectiveness of the models.

Automated summary

The study compared the application of the Health Belief Model and the Theory of Planned Behavior in mammography screening, finding both models to have positive explanatory value, but most studies failed to consistently report on the effectiveness of the models.