The health belief model and theory of planned behavior applied to mammography screening: A systematic review and meta‐analysis
Open accessAbstract
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 R2 = .55), while the explained variance for TPB ranged from 16% to 81% (mean R2 = .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.
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Motivation is positively associated with screening attendance.
“Motivation has been positively associated with screening attendance [9,14,17,18].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [14]
The review and meta-analysis (p. 11) reports that health motivation was negatively, not positively, associated with mammography screening behavior (OR 0.94; 95% CI 0.89–1.00). It separately reports a positive association for intention, which is a different construct. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn systematic reviews, perceived control in personal health choices and high self-efficacy to attend screening are positively associated with screening.
“In systematic reviews, perceived control in personal health choices and high self-efficacy to attend screening have been positively associated with screening [7,10,11,14].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [14]
The meta-analysis reports perceived behavioral control as negatively, not positively, associated with mammography screening behavior (p. 11; OR 0.99, 95% CI 0.96–1.02). The Background (p. 4) defines self-efficacy as confidence to act but does not report that high self-efficacy is positively associated with screening. (LLM, conf=0.86)
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Experimental — accuracy not yet measuredPositive attitudes towards cancer screening are associated with increased BC and CC screening.
“In systematic reviews comparing different health behaviour theory constructs, positive attitudes towards cancer screening have been associated with increased BC and CC screening [11,14].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [14]
The HBM & TPB: Review & Meta-analysis section (p. 11) reports the opposite direction for breast-cancer mammography screening: attitudes had a mean odds ratio of 0.98 and were described as negatively associated with screening behavior. The paper addresses mammography screening, not cervical-cancer screening, so it does not establish the cervical-cancer part of the claim. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe odds of getting screened for BC were OR 1.72 compared to those with no intention.
“The odds of getting screened for CC were OR 1.8 [11] and OR 1.72 for BC [14] compared to those with no intention.”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [14]
The meta-analysis (p. 11) reports a mean OR of 1.72 for the association between intention and mammography screening behavior. It does not specify that the comparison group was people with no intention to screen, so that part of the claim is not established by our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPerceived benefits such as reassurance of not having cancer or detecting cancer at a treatable stage are positively related to cancer screening.
“Perceived benefits such as reassurance of not having cancer or detecting cancer at a treatable stage have been positively related to cancer screening [8,11,14,17,20].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [14]
The Explanatory Value of the Models section (p. 10) reports a positive association between perceived benefits and mammography screening (mean OR 1.42, 95% CI 1.34–1.51). The Background (p. 3) describes detection at a more treatable stage, but our copy does not identify reassurance of not having cancer as a perceived benefit associated with screening. The review is also specific to mammography rather than cancer screening generally. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Social supports facilitate self-efficacy, which in turn is associated with screening attendance.
“Such supports are important because they facilitate self-efficacy, which in turn is associated with screening attendance [7,10,11,14].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [14]
The Background (p. 4) identifies self-efficacy as a health-belief-model construct, and the review (p. 5) describes perceived behavioral control as serving a similar function. But the paper does not say that social supports facilitate self-efficacy; its reported association between perceived behavioral control and mammography screening behavior is weak and negative (p. 11), not evidence for the proposed pathway to attendance. (LLM, conf=0.77)
Experimental — accuracy not yet measured
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Cited by
Sorted by citations
The application of health behavior theories to promote cervical cancer screening uptake
Dsouza, J. P., Van den Broucke, S., Pattanshetty, S., & Dhoore, W. (2021) · Public Health Nursing · doi:10.1111/phn.12944 · Cited by 27 · see citing works
Dsouza, J. P., Van den Broucke, S., Pattanshetty, S., & Dhoore, W. (2022) · BMC Women's Health · doi:10.1186/s12905-022-02019-y · Cited by 20 · see citing works
Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review
Palsola, M., Likki, T., Snijders, V., Corbex, M., Lasierra, L., & Curtis, B. (2026) · Glasnik javnog zdravlja · doi:10.5937/serbjph2601086p
- Authors
- Ritchie, D., Van den Broucke, S., & Van Hal, G.
- Affiliations
- University of Antwerp (BE)
- Faculty of Psychology and Educational Sciences and the Psychological Sciences Research Institute Université Catholique de Louvain Louvain‐la‐Neuve Belgium
- Department of Epidemiology and Social Medicine University of Antwerp Antwerp Belgium
- Corresponding author
- Ritchie, David
- Venue
- Public Health Nursing
- Publisher
- Wiley
- Published
- 2020-11-30
- Volume
- 38
- Issue
- 3
- Pages
- 482-492
- ISSN
- 0737-1209 (ISSN-L)
- 1525-1446
- OpenAlex
- W3107240037
- Cited by
- 87
- References
- 4
- Citations by year
- 2026: 27 · 2025: 22 · 2024: 12 · 2023: 14 · 2022: 10 · 2021: 2
- FWCI
- 1.02
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Public Health Nursing (publishedVersion)
- PubMed (publishedVersion)
- DIAL (Catholic University of Leuven) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- Health Belief Model, theory of planned behavior, mammography screening, screening behavior, cues to action, explained variance, intention, cognitive factors, health behavior theory
- MeSH terms
- Health Belief Model, Humans, Mammography, Health Behavior, Intention, Early Detection of Cancer
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