Analyzing the Association between Regular Exercise and Breast Cancer Screening Practice Using the Knowledge-Attitude-Behavior (KAB) Model?

Background and Purpose: Korean American (KA) women have experienced high prevalence and low survival rates of breast cancer (BC). Moreover, non-US-born KA women tend to have a higher prevalence of BC compared to those born in the U.S. Despite the disproportionate BC burden, a systematic review indicated that their BC screening rates (34–57%) remain lower than the national target (81.1%) specified by Healthy People 2020. Existing literature shows evidence of a link between regular exercise and cancer screening, but little is known about this relationship among older KA women. A better understanding of such association would help community health educators and oncology social workers to develop effective strategies for promoting BC screening that leverage exercise in KA community. Thus, this study aimed to examine how regular exercise is associated with BC screening practice among older KA women using the Knowledge‐Attitude‐Behavior (KAB) model as a theoretical framework. The KAB model has been used in the health promotion contexts, positing that accumulations of knowledge in a health behavior domain influence attitudes toward the health behavior, resulting in change of the behavior over some period of time.

Methods: A cross-sectional survey design was used to collect quantitative data regarding times of moderate or greater exercise (20-60 minutes at a session) per week, receipt of BC screening within the past two years, BC knowledge, attitudes toward BC screening, self-efficacy for BC screening, BMI, health insurance, and sociodemographics from KA women aged 50 to 80. Purposive sampling was performed to recruit eligible study participants from May 2015 to February 2016 in the Atlanta metropolitan area, and a total of 307 KA women completed self-report survey questionnaires. Descriptive and multiple logistic regression analyses were conducted using Stata/SE 14.1.

Results: The descriptive analyses showed that 68% reported ≥ 1 time of exercise per week and 32% reported ≥ 3 times of exercise per week, while 49% had undergone BC screening. Among individuals reporting BC screening, 74% had ≥ 1 time of exercise per week and 38% had ≥ 3 times of exercise per week. Comparatively, among those reporting no BC screening, 62% had ≥ 1 time of exercise per week; 26% had ≥ 3 times of exercise per week. The multiple logistic regression analysis showed that individuals reporting BC screening were more likely than those reporting none to do ≥ 3 times of exercise per week (OR=1.87; 95% CI=1.00–3.47), holding other variables constant.

Conclusions and Implications: This study contributes to the existing body of literature pertaining to BC screening practice among KA women by identifying its association with regular exercise. The findings provided implications for culturally-specific interventions designed to encourage KA women’s initiation and maintenance of regular excise and BC screening. The findings suggest collaborative efforts for preventive health education among health professionals and social workers at primary and secondary healthcare settings. Future research should investigate the causal-effect relationship and how the readiness for exercise is associated with BC screening among underserved communities.