Predicting the Determinants of Colorectal Cancer Screening Behaviors Using Protection Motivation Theory: A Cross-Sectional Partial Least Squares Structural Equation Modeling Analysis

IF 2.1 Q2 MEDICINE, GENERAL & INTERNAL

Health Science Reports Pub Date : 2025-09-26 DOI:10.1002/hsr2.71295

Mahdi Gholian-Aval, Bahareh Behrouzi, Jamshid Jamali

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Abstract

Background

Colorectal cancer (CRC) screening reduces mortality by 40%–60%, yet participation remains low globally. In this study, we applied protection motivation theory (PMT) to identify determinants of CRC screening behavior in Iran using partial least squares structural equation modeling (PLS-SEM).

Design and Methods

This cross-sectional study was conducted on 433 adults over 50 years of age using stratified sampling in Neyshabur, Iran in 2024. Participants completed a validated 43-item PMT questionnaire assessing key cognitive factors (perceived sensitivity, severity, self-efficacy, response efficacy, response costs, fear, rewards, and behavioral intention), with self-reported screening behavior as the outcome.

Results

Among the PMT constructs, self-efficacy had the highest mean score (69.43 ± 18.97 out of 100), while actual screening behavior had the lowest (26.12 ± 9.93 out of 100). PLS-SEM analysis revealed significant pathways: perceived severity (β = 0.118, p = 0.030) and response efficacy (β = 0.172, p = 0.003) positively influenced behavioral intention, while perceived rewards negatively impacted intention (β = −0.197, p < 0.001). Fear mediated sensitivity/severity effects on intention (β = 0.155, p = 0.003). Notably, self-efficacy and response costs showed nonsignificant relationships with intention.

Conclusion

Participants demonstrated moderate intention (54.8 of 100) yet low screening behavior (26.1 of 100), highlighting a critical intention–behavior gap. While PMT constructs effectively predicted screening intention, their limited ability to explain behavior underscores the influence of contextual barriers beyond cognitive appraisals in this Iranian cohort. Future interventions should integrate PMT-based education targeting threat appraisal with system-level strategies (e.g., mailed test kits, navigational support) to bridge this implementation gap.

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使用保护动机理论预测结直肠癌筛查行为的决定因素：横截面偏最小二乘结构方程建模分析

结直肠癌（CRC）筛查可降低40%-60%的死亡率，但全球参与率仍然很低。在这项研究中，我们应用保护动机理论（PMT），利用偏最小二乘结构方程模型（PLS-SEM）确定伊朗结直肠癌筛查行为的决定因素。设计与方法本横断面研究于2024年在伊朗Neyshabur采用分层抽样方法对433名50岁以上的成年人进行了研究。参与者完成了一份43项经验证的PMT问卷，评估关键认知因素（感知敏感性、严重程度、自我效能、反应效能、反应成本、恐惧、奖励和行为意图），并以自我报告的筛选行为为结果。结果在PMT构念中，自我效能得分最高（69.43±18.97），实际筛查行为得分最低（26.12±9.93）。PLS-SEM分析显示，感知严重性（β = 0.118, p = 0.030）和反应效果（β = 0.172, p = 0.003）正向影响行为意愿，感知奖励负向影响行为意愿（β = - 0.197, p < 0.001）。恐惧介导的敏感性/严重性对意向的影响（β = 0.155, p = 0.003）。值得注意的是，自我效能感和反应成本与意向的关系不显著。结论：参与者表现出中度意向（54.8 / 100）和低筛选行为（26.1 / 100），突出了一个关键的意向-行为差距。虽然PMT构建了有效的预测筛选意向，但其解释行为的有限能力强调了在伊朗队列中超越认知评价的情境障碍的影响。未来的干预措施应将基于pmt的针对威胁评估的教育与系统级战略（例如，邮寄测试包、导航支持）结合起来，以弥合这一实施差距。

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