| ObjectiveThis study aimed to investigate knowledge level of gastric cancer risk factors and warning symptoms,the status of screening behavior and related socio-demographic factors among high-risk population of gastric cancer;and to develop a questionnaire of gastric cancer screening intention,construct a model of gastric cancer screening intention,and analyze social psychological factors affecting gastric cancer screening intention based on the theory of planned behavior.Methods(1)Status survey.From May to October 2018,using a cluster random sampling method,1267 people at risk for gastric cancer were selected from the population undergoing a physical examination at 11 tertiary hospital medical examination centers in Hunan Province.A self-designed questionnaire about risk factors and warning symptoms of gastric cancer,behavior and attitude towards gastric cancer screening was used to investigate gastric cancer awareness and screening behaviors among high-risk population of gastric cancer.(2)Questionnaire development.From November 2018 to January 2019,based on the planned behavior theory,an interview outline of the questionnaire was formulated.Semi-structured in-depth interviews were conducted with 10 individuals who at high risk of gastric cancer selected and their behavioral belief,norm belief and control belief were acquired.Then,a questionnaire of gastric cancer screening intention consisting of behavioral attitude,subjective norm,perceived behavioral control and behavioral intention was developed.After screening and modifying items based on comments of experts and results of expert content validity,the discrimination and internal consistency of the questionnaire were evaluated by pretesting it in 200 adults at high risk of gastric cancer.(3)Construct a structural equation model.From February to July 2019,the testing questionnaire was distributed among 475 participants,and exploratory factor analysis was performed to further screen items,then confirmatory factor analysis was performed on each dimension of the questionnaire.Finally a structural equation model was constructed to analyze effects of each variable to behavioral intention.Results(1)The final response rate was 93.92%(n=1190).The mean score for gastric cancer knowledge was(5.99±5.27)while the total score was 22 points.There were 68.7% of the participants who had a low knowledge level about the risk factors and warning symptoms of gastric cancer while 8.7% of the participants had a high knowledge level.Independent factors related to knowledge levels included age,educational level,occupation,income,a family history of gastric cancer and having upper gastrointestinal tract diseases(P<0.05).In total,207 participants(17.4%)had undergone gastric cancer screening.Factors independently associated with screening behavior included higher educational level,higher income and having upper gastrointestinal tract diseases(P<0.05).(2)From semi-structured in-depth interviews,six behavior beliefs were identified: being beneficial for early detection of gastric diseases,being beneficial for early detection of gastric cancer,being beneficial for early detection of gastric cancer and timely treatment,pain of gastric cancer screening with gastroscopy,high cost of gastric cancer screening,and poor results of gastric cancer screening.Four normative beliefs were identified: family,spouse,community doctor or outpatient doctor,friend.Six control beliefs were identified: high cost of gastric cancer screening,do not covered by medical insurance,uncomfortable gastroscopy screening,no symptoms,no recommendation to do screening from doctors,and inconvenient screening process.Based on these beliefs,the TPB questionnaire was developed with 4 dimension(attitude,subjective norms,perceived behavior control,and behavior intention)and 22 items.After evaluating the content validity of the experts,two items were deleted.The content validity of the item level was 0.9-1.The overall consistency content validity of the questionnaire level was 1.The Cronbach's ? coefficient of the questionnaire was 0.844.(3)After exploratory factor analysis,three items were deleted,and 4 common factors were obtained,which was consistent with the dimensions of the theoretical assumptions,and a total variance of 66.31% was explained.After confirmatory factor analysis,the standardization factor load value of each item was good,and the values of composite reliability of the four dimensions were 0.725-0.887.The values of average variance extraction were 0.469-0.611.The Cronbach's ? coefficient of each dimension was 0.878,0.831,0.840 and 0.723,respectively.The Cronbach's ? coefficient of the questionnaire was 0.796.The average score of the questionnaire was(68.29 ± 6.74)points,and the average score of 19 items was(3.59 ± 0.35)points.The fitting indexes of structural equation model was all good.This model accounts for 36% of gastric cancer screening intention of participants.Perceived behavioral control and behavioral attitudes have significant effects on screening intentions,and the standardized coefficients of their effect on intention were 0.487 and 0.151,respectively.Conclusions(1)People with high risk of gastric cancer had a low knowledge level about risk factors and warning symptoms of gastric cancer.Age,educational level,occupation,economic income,family history of gastric cancer,and gastric-related diseases are factors that influence the level of gastric cancer knowledge.A majority of people with high risk of gastric cancer have a positive attitude towards the benefits of gastric cancer screening,but the screening rate for gastric cancer is still low.Educational level,income,and stomach-related diseases are independent factors that affect the screening behavior.(2)Gastric cancer screening intention questionnaire based on planned behavior theory has good reliability and validity,which could be used to explore the social psychological factors of gastric cancer screening intention.(3)The model fitting effect based on planned behavior theory is good,and the theoretical model is compatible with the data.The structural equation model constructed in this study validates the application of planned behavior theory in the field of gastric cancer screening intentions of people with high risk of gastric cancer,that is,the screening behavioral attitude and perceived behavioral control have a direct positive effect on screening behavior intentions and subjective norms have no significant effect on screening behavior intention.The key points of screening intention and behavior intervention are to enhance the control of perceived behavior and promote positive attitude. |
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