Survey on determinants of intention to reduce nasopharyngeal cancer risk: an application of the theory of planned behavior

Background To have better prognostic outcomes and minimize deaths due to nasopharyngeal cancer, it is vital to understand factors that motivate the public to undertake cancer preventive measures. The study investigated determinants of intention to adopt measures to reduce nasopharyngeal cancer risk using the Theory of Planned Behavior. Method A cross-sectional survey was conducted on Malaysians (n = 515) using a questionnaire on attitudes, subjective norm, perceived behavioral control, knowledge of nasopharyngeal cancer, past nasopharyngeal cancer preventive behavior, and intention to adopt preventive measures. The attitudes construct encompassed perceptions of susceptibility, severity, benefits and barriers. Hierarchical regression of mediation effect under structural equation model approach was used to test the theory. The model was re-estimated using the two-stage least square approach by instrumental approach. Next the Maximum Likelihood Estimation-Structural Equation Modeling was conducted to gauge the instrumentation and check the robustness of the model's simultaneity. Results The respondents had moderate knowledge of nasopharyngeal cancer, and reported high levels of perceived risk, perceived severity and perceived behavioral control. The respondents were under little social pressure (subjective norm) to perform nasopharyngeal cancer preventive actions, marginally believed in the benefits of medical tests and reported few barriers. The Partial Least Squares-Structural Equation Modeling results show that the relationship between intention and four independent variables were significant (perceived behavioral control, perceived risk, perceived severity, marital status) at p < .05. Tests of Two-stage Least Square Approach and Maximum Likelihood Estimation-Structural Equation Modeling confirm the four key factors in determining the intention to reduce nasopharyngeal cancer risk. The variance explained by these factors is 33.01 and 32.73% using Two-stage Least Square Approach and Maximum Likelihood Estimation-Structural Equation Modeling respectively. Intention to undertake nasopharyngeal cancer risk-reducing behavior has no significant relationship with subjective norm, attitudes (perceived benefits and barriers to screening), knowledge of nasopharyngeal cancer and past behavior in enacting nasopharyngeal cancer preventive measures. The only demographic variable that affects intention is marital status. Gender, age, race, religion, education level, and income are not significantly associated with intention. Conclusions In contexts where knowledge of nasopharyngeal cancer is moderate, the factors associated with the intention to reduce risk are perceived risk and severity, perceived behavioral control, and marital status.