Determinants of self-reported sustained breast cancer screening among women in Shenzhen, China: a study based on the health belief model

BACKGROUND: Breast cancer is the most commonly diagnosed cancer among women worldwide. In Shenzhen, breast cancer screening is available through both a government-funded free program and a range of out-of-pocket or employer-sponsored options; however, evidence on factors associated with sustained screening remains limited. This study aimed to examine the direct and indirect associations of sociodemographic and health-related characteristics and health belief model (HBM) constructs with self-reported sustained breast cancer screening among women in Shenzhen, China. METHODS: A cross-sectional survey was conducted in Shenzhen, China, from November to December 2024, using multi-stage cluster sampling. Data on sociodemographic characteristics, health-related factors, and HBM constructs (five-point Likert scale) were collected. A structural equation model (SEM) was constructed to examine direct and indirect pathways linking sociodemographic characteristics, health-related factors, and HBM constructs to self-reported sustained breast cancer screening. Model fit was assessed using chi-square statistic divided by degrees of freedom (χ²/df), comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR). RESULTS: A total of 1,665 women were analyzed; 70.2% (1,169/1,665) had self-reported sustained breast cancer screening. The SEM showed good fit ( χ 2 / df =3.635; CFI = 0.960; TLI = 0.924; RMSEA = 0.040, SRMR = 0.022). Among the six HBM constructs, cues to action (β standardized = 0.106, p = 0.013) were positively associated with self-reported sustained breast cancer screening, whereas perceived barriers (β standardized = -0.165, p < 0.001) were negatively associated with this outcome. Additionally, age (β standardized = -0.010, p = 0.029), educational level (β standardized = 0.020, p < 0.001), average monthly income per household (β standardized = 0.016, p = 0.002), and history of breast diseases (β standardized = 0.011, p = 0.011) were indirectly associated with self-reported sustained breast cancer screening through perceived barriers. Moreover, history of breast diseases (β standardized = 0.013, p = 0.028) was additionally indirectly associated with self-reported sustained breast cancer screening through cues to action. Furthermore, age (β standardized = -0.003, p = 0.045), marital status (β standardized = 0.003, p = 0.019) and history of breast diseases (β standardized = 0.005, p < 0.001) were indirectly associated with self-reported sustained breast cancer screening through the sequential pathway involving cues to action and perceived barriers. CONCLUSION: Cues to action and perceived barriers were key factors associated with self-reported sustained breast cancer screening. Targeted interventions that strengthen cues to action and reduce perceived barriers may help promote sustained breast cancer screening.