Journal of Gerontological Nursing

WOMEN'S HEALTH BELIEFS ABOUT Breast Cancer and Health Locus of Control

Mary Tittle, PhD, RN; Meredith Chiarelli, MS, ARNP; Karen McGough, MS, ARNP; Sandie Jones McGee, MS, ARNP; Susan McMillan, PhD, ARNP, FAAN

Abstract

TABLE 1

FREQUENCY AND PERCENT OF WOMEN BY AGE GROUP, CANCER DIAGNOSIS, AND MARITAL STATUS

TABLE 2

CHI-SQUARE FOR FREQUENCY OF RESPONSES OF YOUNGER AND OLDER WOMEN TO ITEM 8. DO ANY OF YOUR FAMILY OR FRIENDS HAVE CANCER?

TABLE 3

CHl-SQUARE FOR FREQUENCY OF RESPONSES BY ACE GROUPS TO ITEMS 1 TO 7 (W = 462)

TABLE 4

ANALYSIS OF VARIANCE TO ANALYZE ASSOCIATIONS BETWEEN YEARS OP EDUCATIOW AND RESPONSES TO SELECTED HEALTH BELIEF ITEMS IN YOUNGER AND OLDER WOMEN

TABLE 5

ANOVA TO ANALYZE RELATIONSHIP AMONG SELECTED HEALTH BELIEF ITEMS AND HEALTH LOCUS OF CONTROL SUBSCALE SCORES FOR YOUNGER AND OLDER WOMEN…

Breast cancer is the most common malignancy in women and accounts for 14% of all cancers in the United States. It is the second leading cause of cancer death in women, and the incidence increases with age. More than 75% of women who are newly diagnosed with breast cancer are older than 50 (American Cancer Society, 1996). Age is the most significant risk factor for development of cancer, yet older adults are less likely to participate in early detection programs as evidenced in part by great under use of mammography benefits by the traditional medical population (Cooper, 1996). In addition, Kottke et al. (1995) reported that age and early detection activities are inversely correlated. This finding is supported by the fact that mammography use decreases with age (Champion, 1994a). Attempts have been made to explain this phenomenon through examination of health beliefs and locus of control (LOC).

As the elderly population grows, it is important for health care providers to continue to address this problem and identify opportunities for improvement. The purpose of this study was to examine health beliefs and health LOC about breast cancer among women of all ages. As health care resources become increasingly sparse, research-based design of early prevention and detection programs becomes critical.

RESEARCH QUESTIONS

The following research questions were addressed in this study:

* What are the relationships between age and health beliefs of women (e.g., attitudes about health in general, perceptions about their susceptibility to breast cancer, beliefs about the benefits of early diagnosis, and perceptions about the seriousness of breast cancer)?

* Are there relationships between age and health LOG subscale scores?

* Are there relationships between years of education and health beliefs?

* Are there relationships between years of education and health LOG subscale scores?

* Are there relationships between health beliefs and having family or friends with cancer?

* Are there relationships between health LOG subscale scores and having family or friends with cancer?

* Are there relationships between women's health beliefs and health LOG?

REVIEW OF LITERATURE

Health Belief Model

The Health Belief Model (HBM) is a paradigm used to predict and explain health behavior and is used by health care professionals to assess variables that influence perceived risks and probabilities for taking health action plans. The HBM addresses concepts such as susceptibility, seriousness, benefits, barriers, health motivation, and confidence.

Health beliefs related to breast cancer are formed by many factors including prior experiences, health knowledge, values, culture, and socioeconomic status. Champion (1993) developed a tool to measure the HBM concepts in relation to breast cancer and breast self-examination (BSE). Using this instrument, Champion (1994a) found that women younger than 50 had a higher compliance rate for mammography than older women. In the older group, mammography compliance was related to having regular Pap tests, having heard about mammography, and beliefs about benefits. Barriers for the older group were significant because they felt the procedure was embarrassing, costly, time consuming, and caused too much worry. Older women appeared to rely more heavily on health care provider recommendation. These findings are consistent with other work of Champion (1991; 1992) and other researchers (Fuller, McDermott, Roetzheim, Sc Marty, 1992; Zabalegui, 1994).

Locus of Control

Locus of control, a construct of social learning theory, is another approach to explain some of the variability in health-seeking behaviors. Locus of control describes the extent to which individuals believe an outcome results from their own actions rather than from an outside force. The belief that the person is in control of outcomes is characteristic of an internal attitude. If people believe outcomes are controlled by forces beyond their control, they are characterized as external. When applied to health behavior, it became evident these characteristics were not bipolar. Rather, there were three distinct areas of belief:

* The extent to which health outcomes are influenced by health care providers (powerful others).

* The belief that health outcomes occur by chance.

* The belief in the person's control (internal).

The Multidimensional Health LOG (MHLC) Scale (Wallston & Wallston, 1978) measures these dimensions. It has been used by other researchers to measure LOG in women practicing BSE (HaIH 1982) and those undergoing mammography (Fajardo, Saint-Germain, Meakem, Rose, & Hulmán, 1992).

Attitudes and Behaviors Toward Breast Cancer Screening

A number of studies have been conducted to assess attitudes toward and knowledge of breast cancer screening. Kottke et al., (1995) found that as age increased, clinical breast examination frequency and mammography testing decreased. Busch et al. (1996) reported similar findings because older women often lack the education and skills to perform BSE properly.

Morrison (1996) identified factors associated with BSE compliance with a population of 204 underinsured, English-speaking women who had low incomes and were at least 40 years old. Morrison reported that BSE behavior is correlated with confidence level, provider influence, exposure to BSE messages from a clinician, and adequate rime devoted to BSE.

Results from a research study by Mah and Bryant (1992) indicated that breast cancer risk factor knowledge was low in women age 40 to 75 who did not have breast cancer. Women younger than 60 had the most knowledge, while women age 70 to 75 were least knowledgeable of breast cancer risks and had lower attitude scores about mammography.

METHODS

This was a descriptive, comparative study. Health beliefs about breast cancer and health LOC among women of all ages were assessed.

Sample

A convenience sample of 500 women of all ages was sought from several settings, including acute care facilities, a cancer center, veterans' hospitals, outpatient clinics, hospice, and private practice. These varied settings ensured that the sample included a range of ages and women who were treated for cancer of all types, as well as those who do not or are not known to have the disease. Women were excluded if they did not read and understand either English or Spanish. In addition, women were excluded if they were acutely ill because of current treatment for cancer or a health professional.

Instrumentation

The Health Screening Questionnaire was developed by Sugarek, Deyo, and Holmes (1988) to collect self-report data about health beliefs related to breast cancer and health LOG. The eight items that measure health beliefs include perceptions about susceptibility to and seriousness of breast cancer, the ability to prevent breast cancer, and the value of early detection. Each item is scored individually (items are not summed). The 16 items that measure health LOC are based on Wallston's Health LOC Scale (HLOC) (Wallston & Wallston, 1978).

Table

TABLE 1FREQUENCY AND PERCENT OF WOMEN BY AGE GROUP, CANCER DIAGNOSIS, AND MARITAL STATUS

TABLE 1

FREQUENCY AND PERCENT OF WOMEN BY AGE GROUP, CANCER DIAGNOSIS, AND MARITAL STATUS

These items are reverse-scored and summed to obtain subscale scores for "chance, " "powerful other," and "internal LOC." A low score on each subscale indicates a greater belief in chance, powerful other, and interna) LOG. liiere is also a Spanish version of the instrument.

Beginning evidence of validity was insured by the manner of development; both sections of the tool were based on well-developed and studied models (Sugarek et al., 1988). During tool development, pilot testing was conducted with low-income women that revealed some difficulty in understanding specific items. Illese items were simplified and responses on the HLOC scale items were simplified to agree, disagree, and do not know.

These changes produced a version that was readily understood by women with limited education. Re-study of the psychometric properties of the questionnaire was conducted. Testretest reliability ranged from .36 to .71, and internal consistency using Cronbach's alpha ranged from .40 to .77 for the HLOC items. Construct validity was examined by correlations ranging from .46 with the Rotter scale to .80 with the original Wallston HLOC.

Standard demographic data were collected to describe the sample. Demographic data included age, ethnicity, cancer or no cancer diagnosis, length of time since diagnosis, marital status, education, and location of care or work (where data were collected).

Procedures

Approvals were obtained in each institutional setting and from the Institutional Review Board at the University of South Florida. After approvals were obtained, data collection began in each site. A group of 21 oncology advanced practice nurses cooperated to collect these data. In the outpatient clinics, potential participants were approached in the waiting room, including patients and family members. In the hospice, female staff members were invited to participate. In acute care settings, nonprofessional staff in the main hospital were invited to participate.

In each setting, women identified as participants had the study explained to them by an investigator. A cover sheet explaining the study with the demographic data form and the Health Screening Questionnaire was given to each participant. Participants were asked to complete both questionnaires and return them to the investigator. To determine which version of the questionnaire to administer, Hispanic women were asked four questions from the Deyo Scale (Sugarek et al., 1988). For participants with a Deyo score of O to 2, the cover sheet and questionnaires were in Spanish. Completing and returning the questionnaires implied consent.

In addition, to increase the accrual of women with a history of cancer, tumor registries in the area were used to identify women who had been treated for cancer of any type, including breast cancer. Hispanic women were contacted by telephone by a bilingual data collector and Black women were contacted by a Black data collector and invited to participate. If they agreed, the questionnaire and demographic data form were mailed to them with a return envelope enclosed. For these women, the Deyo Scale was asked via telephone to determine whether to mail English or Spanish forms. If the forms were not returned within 2 weeks, a second set was mailed with a reminder note.

Table

TABLE 2CHI-SQUARE FOR FREQUENCY OF RESPONSES OF YOUNGER AND OLDER WOMEN TO ITEM 8. DO ANY OF YOUR FAMILY OR FRIENDS HAVE CANCER?

TABLE 2

CHI-SQUARE FOR FREQUENCY OF RESPONSES OF YOUNGER AND OLDER WOMEN TO ITEM 8. DO ANY OF YOUR FAMILY OR FRIENDS HAVE CANCER?

Data Analysis

Frequencies, percentages, means, and standard deviations were used to describe the sample. Data were analyzed to answer the research questions using chi-square, f-tests, Pearson correlation coefficients, and analysis of variance (ANOVA).

RESULTS

Sample

A total of 487 questionnaires were completed and returned. Of the total number, 25 were unusable because of omissions and incomplete data, leaving a final sample of 462. Of the 462, the largest number of women were White (n = 197), with slightly smaller groups of Black women (n = 152) and Hispanic women (n = 1 13). No significant differences were found among ethnic groups by age (p = .164). The mean age of the total group was 52.4 years, but the ages ranged from 19 to 93 years. The mean years of education was 12.9 years, but with a wide range reported (1 to 24 years).

The women were divided into groups of younger than 55 and 55 and older for many of the analyses. The 1987 Health Statistics on Older Persons identifies the ages of 55 and 64 as the younger limits of older individuals (Public Health Service, 1987). For the purpose of this study, the older age group was defined as starting after age 55. The younger group (n = 261) accounted for 56.5% of the total group.

In the older group, a larger percentage of women (47.8%) had a personal history of cancer than in the younger group (28.0%). The majority of women in the younger group (57.1%) were married. That percentage was somewhat lower in the older group (43.3%) who were more likely than the younger group to be widowed (Table 1).

A significant difference (p = .01) was found between the younger and older groups in the number who reported having family or friends with cancer (Table 2). Most women in both groups had family or friends with cancer, but the percentage was significantly higher in the older group.

Research Question 1. What are the relationships between age and health beliefs of women (e.g., attitudes about health in general, perceptions about their susceptibility to breast cancer, beliefs about benefits of early diagnosis, perceptions about the seriousness of breast cancer)?

No significant differences were found between the age groups related to general attitudes about health. There also were no significant differences by age group in perceived susceptibility to cancer or breast cancer. Regarding whether breast cancer can be prevented, there was a significant difference in the groups (p = .008) with the younger group more likely to say breast cancer cannot be prevented. When asked about the seriousness of cancer, a significant difference (f> = .000) was found between the two groups, with the younger group more likely to believe cancer causes death. Regarding the benefit of early detection, there were no significant differences in the age groups (Table 3).

Research Question 2. Are there relationships between age and health LOG subscale scores?

No correlation was found between age and scores on the internal subscale of the HLOC. However, on the other two subscales, significant negative correlations were found. A weak negative correlation was found between age and chance (r = -.17, ? = .000), and a weakto-moderate negative correlation was found between powerful other and age (r = -.39, p = .000), indicating that older women had a somewhat stronger belief in chance and powerful other.

Research Question 3. Are there relationships between years of education and health beliefs?

Table

TABLE 3CHl-SQUARE FOR FREQUENCY OF RESPONSES BY ACE GROUPS TO ITEMS 1 TO 7 (W = 462)

TABLE 3

CHl-SQUARE FOR FREQUENCY OF RESPONSES BY ACE GROUPS TO ITEMS 1 TO 7 (W = 462)

ANOVA was used to examine significant associations between years of education and responses on each health belief item. Significant associations were found on selected items only in the women 55 and older. More years of education were significantly associated with believing in preventing breast cancer in the older group. In the older group, those with the least education were more likely to believe that all or most die. Those with the most education believed approximately half of women with breast cancer can be cured. Those with the most education were more likely to believe in the benefits of early diagnosis (Table 4).

Research Question 4. Are there relationships between years of education and health LOG subscale scores?

Significant weak-to-moderate positive relations were found between years of education and chance scores (r = .34, ? - .000) and powerful other scores (r = .34, ? = .000) indicating that those with less education were somewhat more likely to believe in chance and powerful others. No relationship was found between education and the internal subscale scores of the HLOC.

Because of the possible confounding effect of education, it was submitted to further analysis. The HLOC subscale scores were compared between older and younger groups using analysis of covariance (ANCOVA) with education as a covariate (the variance contributed by education was separated out). There was no significant difference in the two age groups on the internal subscaie (p = .112), but significant differences were found for the chance subscale (? = .000) and for the powerful other subscale (? = .000).

Table

TABLE 4ANALYSIS OF VARIANCE TO ANALYZE ASSOCIATIONS BETWEEN YEARS OP EDUCATIOW AND RESPONSES TO SELECTED HEALTH BELIEF ITEMS IN YOUNGER AND OLDER WOMEN

TABLE 4

ANALYSIS OF VARIANCE TO ANALYZE ASSOCIATIONS BETWEEN YEARS OP EDUCATIOW AND RESPONSES TO SELECTED HEALTH BELIEF ITEMS IN YOUNGER AND OLDER WOMEN

Research Question 5. Are there relationships between health beliefs and having family or friends with cancer?

The item asking about whether the women had family or friends with cancer was converted to a dichotomous scale with "no" and "don't know" being treated as negative responses, and "family," "friends," and "both family and friends" being treated as a positive response. Significant associations were found between having family or friends with cancer and the belief they may get cancer themselves (chisquare 25.66, p = .000). The women reporting friends or family with cancer were significantly more likely to feel susceptible to cancer themselves (chi-square 24.77,/? = .006).

Research Question 6. Are there relationships between health LOG subscale scores and having family or friends with cancer?

Using independent t-tests, subscale scores of the HLOC were compared for the women giving yes or no answers to the item about family or friends having cancer. A significant difference was found on the internal subscale (i = 2.61, p = .009) with women reporting having no family or friends with cancer being more internally motivated. No significant differences were found on the other two subscales.

Research Question 7. Are there relationships between women's health beliefs and health LOG?

Using ANOVA, other subscale scores on the HLOC were analyzed for relationships with health belief items. Items with significant findings (p = < .05) are presented in Table 5. Beliefs about health (whether luck or controlled by self) were significantly associated with both internal and chance subscale scores for the younger women, with those having the strongest belief in chance reporting that health is a matter of luck. More worry about health was significantly associated with greater belief in powerful others in both groups of women.

Older women who were internally motivated were significantly more likely to deny they might ever get cancer. Feeling susceptible to breast cancer was significantly associated with internal subscale scores in younger women.

Belief that they could prevent breast cancer was significantly associated with believing in powerful others in younger women. Among older women, those who believe they can prevent breast cancer were the most internally motivated, and those who said they did not know were more likely to believe in chance.

Women 55 years and older were significantly more likely to believe that all will die of breast cancer if they had a stronger belief in chance. Older women who were more internally motivated were more likely to indicate they were unsure about how serious breast cancer would be.

Beliefs about the value of early detection were significantly associated with all three subscale scores in the older women. Older women with the strongest belief in chance or powerful others were more likely to doubt the value of early detection or be unsure. Women who were more internally motivated stated they were unsure. Among younger women, those who believe early detection gives the woman longer to worry and be sick had a greater belief in chance.

DISCUSSION

Sample

For comparison purposes, the sample was divided into two groups, those younger than 55 and those 55 and older. A strength of the sample was the strong minority representation, which was approximately equal in both groups. No significant difference was found among ethnic groups by age. There was a larger percentage of older women who had a personal history of cancer. This was expected because the incidence of cancer increases with .age. The majority of women in both groups had family or friends with cancer, but the older women had a significantly higher percentage, as would be expected.

Research Question 1. Although no significant differences were found between the age groups related to general attitudes about health and perceived susceptibility to cancer or breast cancer, younger women were more likely than older women to say breast cancer cannot be prevented and cancer causes death. This may indicate a lack of knowledge about treatment and risk factors related to cancer in younger women. Although age was not a variable, Hallal (1982) also found women who believed in susceptibility to cancer were compliant with BSE. Mah and Bryant (1992) also found older women had lower attitude scores related to mammography.

Table

TABLE 5ANOVA TO ANALYZE RELATIONSHIP AMONG SELECTED HEALTH BELIEF ITEMS AND HEALTH LOCUS OF CONTROL SUBSCALE SCORES FOR YOUNGER AND OLDER WOMEN

TABLE 5

ANOVA TO ANALYZE RELATIONSHIP AMONG SELECTED HEALTH BELIEF ITEMS AND HEALTH LOCUS OF CONTROL SUBSCALE SCORES FOR YOUNGER AND OLDER WOMEN

Older women may be less likely to think cancer causes death because of the greater experience they report having with individuals with cancer. Older women were more likely to have family or friends, or know of individuals who had cancer, and thus may have had experience with those who are cured or have lived with it for a number of years.

Research Question 2. On the subscales of LOG, older women were more likely to believe in chance and in powerful others. This is similar to the results of Champion (1994a) who found older women rely more on health care provider recommendations. Powerful other may imply a physician or someone an individual may believe is in control of the cancer or disease process.

One explanation may be a generations] difference in attitudes among women. Older women grew up in a time when blind adherence to medical directives was the norm. In addition, as women have become liberated, they may feel less dependent on a powerful other. Hallal (1982) reponed that women who were not dependent on a powerful other were more compliant with BSE.

Research Question 3. In examining relationships between years of education and health beliefs, significant associations were found only in the older group. As one might expect, older women with more education were more likely to believe in preventing breast cancer and in the benefits of early diagnosis. This is similar to the study by Busch et 'al. (1996) that found older women did not have the education and skills to perform BSE.

Champion (1994b) found that higher education and younger age were significant predictors of compliance with mammography. Older women with less education were more likely to believe all or most women with breast cancer die. This is unusual, as one would expect associations related to education and health beliefs would be the same, no matter the age. This was not true in younger women, leading to one possible explanation that life experience or other factors are important in health beliefs.

Research Question 4. In examining years of education and LOG, it was found that those with less education were more likely to believe in chance and powerful other. This result might suggest education rather than age is affecting LOG. However, ANCOVA allowed the effect of education to be partialled out and the age groups were still significantly different. Thus, the researchers concluded that both age and education independently affect LOC.

The alternative, that more education would be associated with the internal subscale, was not found to be true. No relationship was found between education and the internal subscale. Increased age results in increased life experience, including a variety of factors (e.g., education), which affect health beliefs.

Research Questions 5 and 6. As expected, significant associations were found between having family or friends with cancer and health beliefs related to susceptibility to cancer. Women who are close to someone who has cancer may have faced the reality that if it could happen to a loved one, it could happen to them.

Along with this result, the investigators found women who had no family or friends with cancer were internally motivated. This may indicate those women felt more in control of their lives when no one close to them had cancer. It may be that after someone they know has cancer, the emotional aspects weigh more heavily than knowledge about treatment of cancer. The LOC of these women may change if they learned of a family member or friend having breast cancer.

Research Question 7. Results examining relationships between women's health beliefs and health LOC were mixed, as was true of other research (Champion, 1994a; Fajardo et al. 1992). It might be expected that relationships between health beliefs and health LOC would not vary based on age. This was not true for this sample.

Depending on the LOC subscale, in some instances, there were significant relationships between the subscale score and certain health beliefs among younger women but not older women, and vice versa. This seems to indicate that differences in women are based on more than age. Factors such as life experience, education, and relationships may affect health beliefs.

PRACTICE IMPLICATIONS FOR GERONTOLOGICAL NURSES

Because women with less education are more likely to depend on chance and powerful others, gerontological nurses need to be educated about breast cancer. Many women rely solely on their patient care provider for information. Information from the primary care provider related to breast cancer and early detection needs to be current.

Women who are older need more broad-based education on breast cancer. Gerontological nurses need to realize that not all women know what to do to prevent breast cancer. Education for older women is needed because they tend to be externally motivated. Younger women also need to be taught that breast cancer can be prevented and not all women diagnosed with it die because of it.

Although younger women are more likely to seek health care related to breast cancer (e.g., mammography, breast examination), not all believed it would keep them from dying from breast cancer. Breast cancer education may not be sent in the right manner to younger women with a more fatalistic view. It is important for health care practitioners to be aware of how to target such education.

All life experiences influence a woman's health beliefs. Not only does a woman's age and education impact her beliefs, her LOG is another influence. As women have become liberated and more independent, their LOG may have changed. Their belief about being able to prevent breast cancer appears to have increased. Unfortunately, women who have not sought independence and more education do not believe they can do anything to prevent breast cancer or decrease the likelihood of dying from the disease. This was seen in older women in general, with less education, regardless of their relationship with anyone who had breast cancer.

Gerontological nurses are the most appropriate health care providers to be active in educating older women. In clinical practice, gerontological nurses can be assertive with older women about the recommendations for BSE and mammography, emphasizing the importance of when these tests need to be conducted. Nurses can assist in educating new nurses to be advocates for older women. They can help new nurses understand what older women may believe about health and health care and ways to best educate this age group.

Gerontological nurses need to be proactive in research in this area. An important area to study is compliance of older women with breast health. The recommendation for breast screening related to age should be examined. As women live longer, research on breast health should focus on the older age groups, such as age 85 to 90 and older.

REFERENCES

  • American Cancer Society. (1996). Breast cancer facts and figures - 1996. Atlanta: Author.
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  • Champion, V.L. (1991). The relationship of selected variables to breast cancer detection behaviors in women 35 and older. Oncology Nursing Forum, JS(4), 733-739.
  • Champion, V.L. (1992). Compliance with guidelines for mammography screening. Cancer Detection and Prevention, 16(4), 253-258.
  • Champion, V.L. (1993). Instrument refinement for breast cancer screening behaviors. Nursing Research, 42(3), 139-143.
  • Champion, V.L. (1994a). Relationship of age to mammography compliance. Cancer Supplement, 74(1), 329-335.
  • Champion, V.L. ( 1994b). Strategies to increase mammography utilization. Medical Care, 32(2), 118-129.
  • Cooper, M. (Ed.). (1996). The Dartmouth atlas of healthcare in the United States. Dartmouth, NH: The American Hospital Association.
  • Fajardo, L.L., Saint-Germain, M., Meakem, TJ., Rose, C., & Hulmán, BJ. (1992). Factors influencing women to undergo screening mammography. Radiology, 184(\\ 59-63.
  • Fuller S.M., McDermott, RJ ., Roetzheim, R.G., & Maity, RJ. (1992). Breast cancer beliefs of women participating in a television-promoted mammography screening project. Public Health Reports, 107(6), 682-690.
  • Hallal, J.C. (1982). The relationship of health beliefs, health locus of control, and self-concept to the practice of breast self-examination in adult women. Nursing Research, 21(5), 137-142.
  • Kottke, T, Trapp, M.A., Fores, M., Kelly, A.W., Jung, S., Novotny, P.J., et al. (1995). Cancer screening behaviors and attitudes of women in southeastern Minnesota. Journal of the American Medical Association, 27.3(14), 1099-1105.
  • Mah, A., & Bryant, H. (1992). Age as a factor in breast cancer knowledge, attitudes, and screening behavior. Canadian Medical Association Journal, 146(12), 2167-2174.
  • Morrison, C. (19%). Determining crucial correlates of breast self-examination in older women with low incomes. Oncology Nursing Forum, 2J(I), 83-92.
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  • Sugarek, N.J., Deyo, R.A., & Holmes, B.C. (1988). Locus of control and beliefs about cancer in a multi-ethnic clinic population. Oncology Nursing Forum, /5(4), 481-486.
  • Wallston, K.P., & Wallston, B.S. (1978). Development of multidimensional health locus of control scales. Health Education Monographs, 6(2), 160-170.
  • Zabalegui, A. (1994). Secondary cancer prevention in the elderly. Cancer Nursing, 17(3), 215-222.

TABLE 1

FREQUENCY AND PERCENT OF WOMEN BY AGE GROUP, CANCER DIAGNOSIS, AND MARITAL STATUS

TABLE 2

CHI-SQUARE FOR FREQUENCY OF RESPONSES OF YOUNGER AND OLDER WOMEN TO ITEM 8. DO ANY OF YOUR FAMILY OR FRIENDS HAVE CANCER?

TABLE 3

CHl-SQUARE FOR FREQUENCY OF RESPONSES BY ACE GROUPS TO ITEMS 1 TO 7 (W = 462)

TABLE 4

ANALYSIS OF VARIANCE TO ANALYZE ASSOCIATIONS BETWEEN YEARS OP EDUCATIOW AND RESPONSES TO SELECTED HEALTH BELIEF ITEMS IN YOUNGER AND OLDER WOMEN

TABLE 5

ANOVA TO ANALYZE RELATIONSHIP AMONG SELECTED HEALTH BELIEF ITEMS AND HEALTH LOCUS OF CONTROL SUBSCALE SCORES FOR YOUNGER AND OLDER WOMEN

10.3928/0098-9134-20020501-09

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