PAPM: Moving Mammogram-Reluctant Women to Screening

Aaron Sweazy

Concordia University of Nebraska

Principles of Health Behavior

MPH515

Dr. Kimberly Brodie

July 27, 2014

PAPM:MOVING MAMMOGRAM-RELUCTANT WOMEN TO SCREENING1

PAPM: Moving Mammogram-Reluctant Women to Screening

Explain how the PAPM model was used to address planning and intervention characteristics in the Costanza et al. (2009) article.

A pilot study was designed to push women who might have neglected going in for routine mammogram screenings into convincing them to do so. The study was conducted with amodified version of the Precaution Adoption Process Model (PAPM). Unlike the traditional seven stage PAPM (DiClemente, Salazar, & Crosby, 2013)., this study added subcategories to fit into the study. Stage four and five of the PAPM were given subcategories to help more clearly define the needs to be addressed of the women in the study. For stage four it was realized the typical idea (Deciding not to act), would be split into those who were totally opposed to the ever receiving a mammogram, and those women who would potentially go get a mammogram if their perceived risk increased. These sub categorized levels of stage four were more clearly defined as definite no and qualified no in that order. Stage five of the PAPM (Deciding to act) was dissected into three subcategorized areas all of which were decidedly yes, just on varying levels. In the first of the three stages women planned to get mammograms every two years or less or potentially had no plans to get one in the next three months (5a). In the second of the three subcategories women were non-committal on nailing down a date in which they would go in for a mammogram, but agreed they would adhere to one in the next three month window (5b). Lastly, women who were ready right then to schedule a mammogram were subcategorized as 5c(Coastanza et al., 2009). By breaking down the categories, the University of Massachusetts Medical School Human Subjects Committee was able to more adequately provide counseling services to pinpoint the exact needs of the women in the study to develop intervention strategies and implementations to convince them to be screened.

Determine and explain if the use of the model made sense based on the description of the model in the appropriate textbook chapter and supplemental materials.

In this study the use of the PAPM did make sense on the basis of the seven stages being utilized, although it was modified and also swayed in some ways in my opinion. Those unaware of the issue (Stage 1) were brought up to speed on the issue. Those unengaged on the issue of the importance of getting a mammogram (Stage 2) were aware of the risks of not getting mammograms, but were naïve in thinking it didn’t pertain to them for one reason or another. The next three stages; deciding about acting (Stage 3), deciding not to act (Stage 4), and deciding to act (Stage 5) were greatly influenced by the utilization of motivational interviewing (MI) and printed materials to skew the opposition by women in getting a mammogram. According to Linda Dubs who is a Licensed Independent Clinical Social Worker (LICSW) in Lincoln, Nebraska, “Motivational Interviewing is how you get someone to buy into making a motivated change from within, and is done so with the way you may direct it.”(L. Dubs, personal communication, July 27, 2014). In some ways stages 3-5 are similar to those of a the Health Belief Model (Boston University School of Public Health, 2013) because patients fear could have caused a perceived severity or susceptibility of why they didn’t need to have a mammogram, perhaps due to their overall health. The likelihood of potentially having breast cancer based on family history could have been an influencing factor to getting a mammogram by many of these women in the study. This aforementioned stage would be in reaction to information obtained and doing something about it or jumping into action (Stage 6) by getting a mammogram. Lastly, by regularly going in for annual checkups and mammograms, the patients would be keeping maintenance (Stage 7) on their bodies and potentially would live longer and more productive lives.

In review of your chosen secondary articles, how did the application of the model differ between the interventions? In your opinion, is one application a better use of the model than the other? Explain.

The first article examined dealt with the consumption of meat during a livestock epidemic. In this article the PAPM was conducted by the means of an online polling and had a few fallacies as a result. The numbers of participants were greater than the PAPM of the Mammogram-Reluctant women with 808 individuals being part of the polling. Due to the larger numbers and a more voluntary approach (all online too), results sometimes were stagnant and it wasn’t uncommon to have procrastination as a blame for responses not being delivered in the study. Given this scenario though, the PAPM model is superior in my opinion because it included a larger portion of individuals, and the information wasn’t skewed by MI influences. Although the PAPM with the MI showed higher participation rates, I think the “don’t care” attitude of the PAPM in meat consumption during a livestock epidemic has some key points, but is skewed as well with the abstaining of information of some individuals based on perceived vulnerability(Sniehotta, Luszczynska, Scholz, & Lippke, 2005).

The second article I observed involved the use of the PAPM toexamine predictors of osteoprotective behavior in epilepsy (Elliott, Seals, & Jacobson, 2007). Surveys were distributed to 223 individuals from various races and both genders. However, only 94 total responded. I will have to say that the MI although it skews the information, it helped in ensuring a large portion of individuals fit into the study, thus giving a more accurate reflection of the overall population of women who may be reluctant to getting a mammogram.

References

Boston University School of Public Health (2013, January 22). The Health Belief Model .Behavioral Change Models. Retrieved from

Coastanza, M. E., Luckmann, R., White, M. J., Rosal, M. C., LaPelle, N., & Cranos, C. (2009, June 11). Moving Mammogram-Reluctant Women to Screening: A Pilot Study. , .

DiClemente, R. J., Salazar, L. F., & Crosby, R. A. (2013). Health Behavior Theory for Public Health: Principles, Foundations, and Applications. Burlington, MA: World Headquarters Jones & Bartlett Learning.

Elliott, J. O., Seals, B. F., & Jacobson, M. P. (2007, July). Use of the Precaution Adoption Process Model to examine predictors of osteoprotective behavior in epilepsy. Seizure, 16.

Sniehotta, F. F., Luszczynska, A., Scholz, U., & Lippke, S. (2005). Discontinuity patterns in stages of the precautionadoption process model: Meat consumption during a livestock epidemic. British Journal of Health Psychology, 221-235.