Theory of Planned Behavior (TPB) Explaining Late Presentation of Breast Cancer in the West Coast of Sabah: A Structural Equation Modelling Approach

Explaining Late Presentation of Breast Cancer Based on Theory of Planned Behaviour

Abstract

Objective: Early detection potentially reduces mortality rates, yet instances of delayed treatment-seeking after symptom onset have been observed, posing significant risks, as late presentation escalates mortality rates among patients. This study aims to delineate the sociodemographic profile of late-presenting breast cancer patients and investigate the Theory of Planned Behavior’s (TPB's) (attitude, subjective norm and perceived behavioural control) on intention to seek medical consultation after breast cancer symptoms, that contributing to delayed presentation.
Methods: This cross-sectional study spanned from January 2022 to December 2022, and 111 eligible participants were selected for inclusion through simple random sampling. Researchers obtained written consent and offered assurances of confidentiality. Ethical approval was granted by the Medical Research and Ethics Committee (MREC) under the Ministry of Health Malaysia (MOH). The questionnaire encompassed socio-demographic data, clinical information, and the TPB constructs. SPSS AMOS version 22 facilitated Structural Equation Modeling for data analysis. Demographic variables and the TPB constructs were integrated into the model.
Results: Participants predominantly fell into the 40-49 and 50-59 age groups (36.9% and 35.1% respectively), were mostly married (78.4%), and had secondary school education (46.8%). The majority belonged to the B40 economic group (78.4%) and resided within 25 km of the hospital (41.4%). Stage II cancer was found to be prevalent during diagnosis (43.2%) and mostly presented 3-6 months after experiencing the symptoms (81.1%). The structural model indicated a reasonable fit. Attitude significantly influenced intention (β1=0.844, p<0.001), followed by perceived behavioural control (β2=0.178, p=0.004). Subjective norm did not significantly affect intention (β2=0.088, p=0.199), suggesting a negative influence on patients’ intention to seek medical consultation.
Conclusion: Interventions enhancing subjective norm efficacy are recommended, emphasising partner, family members, peers, physician, and media involvement.