A belief-based model for general, breast, cervical, and colorectal cancer screening adherence intentions among low-income urban women

Abstract

Cancer is a leading cause of morbidity and mortality among women globally, particularly breast, cervical, and colorectal cancers. Despite available screening services in Malaysia, adherence among low-income urban women remains suboptimal. This study aimed to assess cancer screening adherence intention (CSAI) and to model the structural and relative influence of belief factors on general and site-specific screening adherence intention among low-income urban women. A cross-sectional study was conducted in Program Perumahan Rakyat communities in Kuala Lumpur. Phase I involved the adaptation and validation of existing instruments alongside the development of new items. The instruments demonstrated strong validity (0.95–1.00) and reliability (0.77–0.97). The exploratory factor analysis and the measurement model exhibited satisfactory psychometric properties. In Phase II, Structural Equation Modelling revealed high CSAI mean scores across cancer types (7.21–7.44). Cancer fatalism negatively influenced general (β = −0.110), breast (β = −0.118), and cervical (β = −0.131) CSAI. Health belief constructs demonstrated stronger negative effects on general (β = −0.411), cervical (β = −0.391), and colorectal (β = −0.365) CSAI. Cancer worry and fear were not directly significant; however, cancer worry showed consistent indirect effects via health belief (β = 0.097–0.119). Previous screening uptake significantly moderated the relationship between health belief and CSAI in general (β = 0.227) and cervical (β = 0.233) models, although moderated mediation effects were not significant. Importance–Performance Map Analysis (IPMA) identified cancer worry as the highest priority for intervention (low performance ≈ 27.9), whereas cancer fatalism showed relatively high performance (≈ 53.0) but low importance. Open-ended responses showed that intrapersonal factors had the greatest influence, followed by interpersonal, organisational, and healthcare system factors, while community-level factors had minimal influence. In conclusion, CSAI was associated with individual belief factors within a broader multilevel context. Cancer screening programmes for low-income urban women should therefore address modifiable beliefs, particularly cancer worry and health beliefs, while incorporating family and social support and strengthening healthcare-system support to promote screening adherence intention.