Fear of negative appearance evaluation and attitude towards mammography: Moderating role of internal health locus of control, cancer worry and age

Background: Mammography screening tends to reduce mortality rate through early detection. One of the barriers to mammography screening is fear of negative appearance evaluation (FNAE). This study investigated the impact of internal health locus of control, breast cancer worries and age on the relationship between FNAE and attitude towards mammography. Methods: A cross-sectional, questionnaire-based survey design was used. Samples were Iranian women, living in Iran, aged at least 30 years old, without any history of cancer, and had not performed mammography previously based on self-report. In total, 823 samples were collected through conducting an online survey from April to June 2016. The questionnaire consisted of several instruments including attitude toward breast cancer screening procedures scale, FNAE scale, the internal dimension of the multidimensional health locus of control, and two items to measure breast cancer worry. Using covariance-based structural equation modeling the model was tested. Results: The interaction of FNAE with internal health locus of control (β = -0.128, P 0.05, CI: -0.200, -0.056), breast cancer worry (β = 0.090, P 0.05, CI: -0.162, -0.017), and age (β =-0.095, P 0.05, CI = -0.163, -0.026) was significant. The three tested moderators dampened the positive relationship between FNAE and negative attitude towards mammography. Conclusion: More information about the screening procedure should be given to women to overcome their fear. The findings indicate the need for interventions seeking to shift women’s health locus of control from external to internal. Women with low level of cancer worry need more attention.