{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:04:08Z","timestamp":1790755448822,"version":"4.1.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n 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 (\u03c7\n 2<\/jats:sup>\n \/\n df<\/jats:italic>\n ), comparative fit index (CFI), Tucker\u2013Lewis index (TLI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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 (\n \n \n \u03c7<\/mml:mi>\n 2<\/mml:mn>\n \/<\/mml:mo>\n df<\/mml:mi>\n <\/mml:math>\n <\/jats:inline-formula>\n =3.635; CFI\u202f=\u202f0.960; TLI\u202f=\u202f0.924; RMSEA\u202f=\u202f0.040, SRMR\u202f=\u202f0.022). Among the six HBM constructs, cues to action (\n \u03b2<\/jats:italic>\n standardized<\/jats:sub>\n \u202f=\u202f0.106,\n p<\/jats:italic>\n \u202f=\u202f0.013) were positively associated with self-reported sustained breast cancer screening, whereas perceived barriers (\n \u03b2<\/jats:italic>\n standardized<\/jats:sub>\n \u202f=\u202f\u22120.165,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) were negatively associated with this outcome. Additionally, age (\n \u03b2<\/jats:italic>\n standardized<\/jats:sub>\n \u202f=\u202f\u22120.010,\n p<\/jats:italic>\n \u202f=\u202f0.029), educational level (\n \u03b2<\/jats:italic>\n standardized<\/jats:sub>\n \u202f=\u202f0.020,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), average monthly income per household (\n \u03b2<\/jats:italic>\n standardized<\/jats:sub>\n \u202f=\u202f0.016,\n p<\/jats:italic>\n \u202f=\u202f0.002), and history of breast diseases (\n \u03b2<\/jats:italic>\n standardized<\/jats:sub>\n \u202f=\u202f0.011,\n p<\/jats:italic>\n \u202f=\u202f0.011) were indirectly associated with self-reported sustained breast cancer screening through perceived barriers. Moreover, history of breast diseases (\n \u03b2<\/jats:italic>\n standardized<\/jats:sub>\n \u202f=\u202f0.013,\n p<\/jats:italic>\n \u202f=\u202f0.028) was additionally indirectly associated with self-reported sustained breast cancer screening through cues to action. Furthermore, age (\n \u03b2<\/jats:italic>\n standardized<\/jats:sub>\n \u202f=\u202f\u22120.003,\n p<\/jats:italic>\n \u202f=\u202f0.045), marital status (\n \u03b2<\/jats:italic>\n standardized<\/jats:sub>\n \u202f=\u202f0.003,\n p<\/jats:italic>\n \u202f=\u202f0.019) and history of breast diseases (\n \u03b2<\/jats:italic>\n standardized<\/jats:sub>\n \u202f=\u202f0.005,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) were indirectly associated with self-reported sustained breast cancer screening through the sequential pathway involving cues to action and perceived barriers.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1936136","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T07:53:26Z","timestamp":1790754806000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of self-reported sustained breast cancer screening among women in Shenzhen, China: a study based on the health belief model"],"prefix":"10.3389","volume":"14","author":[{"given":"Shuyan","family":"Jin","sequence":"first","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Ma","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueyu","family":"Yang","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxia","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Li","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqin","family":"Gu","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Wu","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.jncc.2025.02.002","article-title":"Global burden of female breast cancer: new estimates in 2022, temporal trend and future projections up to 2050 based on the latest release from GLOBOCAN","volume":"5","author":"Zhang","year":"2025","journal-title":"J Natl Cancer Cent"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"221","DOI":"10.3760\/cma.j.cn112152-20240119-00035","article-title":"Cancer incidence and mortality in China, 2022","volume":"46","author":"Zheng","year":"2024","journal-title":"Zhonghua Zhong Liu Za Zhi"},{"key":"ref3","year":"2024"},{"key":"ref4","year":"2021"},{"key":"ref5","first-page":"2375","article-title":"Analysis of age characteristics of female breast cancer incidence in Shenzhen from 2001 to 2015","volume":"46","author":"Xu","year":"2019","journal-title":"Xian Dai Yu Fang Yi Xue"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1615","DOI":"10.1001\/jama.2015.13183","article-title":"Benefits and harms of breast cancer screening: a systematic review","volume":"314","author":"Myers","year":"2015","journal-title":"JAMA"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/09691413231186686","article-title":"Beneficial effect of repeated participation in breast cancer screening upon survival","volume":"31","author":"Duffy","year":"2024","journal-title":"J Med Screen"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1148\/radiol.2021203935","article-title":"Beneficial effect of consecutive screening mammography examinations on mortality from breast cancer: a prospective study","volume":"299","author":"Duffy","year":"2021","journal-title":"Radiology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s10549-025-07754-y","article-title":"Adherence to breast screening guidelines and breast cancer mortality: a population cohort study","volume":"213","author":"Christensen","year":"2025","journal-title":"Breast Cancer Res Treat"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.7507\/1007-9424.202509027","article-title":"Expert consensus on breast cancer screening in Chinese female with dense breast (2025 edition)","volume":"32","year":"2025","journal-title":"Chin J Bases Clin Gen Surg"},{"key":"ref11","year":"2024"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e0344253","DOI":"10.1371\/journal.pone.0344253","article-title":"A cost-effective breast cancer screening strategy for urban China: findings from a Shenzhen-based modeling study","volume":"21","author":"Tu","year":"2026","journal-title":"PLoS One"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1186\/s12905-024-03096-x","article-title":"Factors influencing breast cancer screening practices among women worldwide: a systematic review of observational and qualitative studies","volume":"24","author":"Tavakoli","year":"2024","journal-title":"BMC Womens Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"12291","DOI":"10.1038\/s41598-024-62218-5","article-title":"Perceived barriers and factors influencing uptake of breast cancer screening among women: a population-based cross-sectional study","volume":"14","author":"Joho","year":"2024","journal-title":"Sci Rep"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e13300","DOI":"10.1111\/ecc.13300","article-title":"Factors affecting mammography screening behaviour among rural Vietnamese women","volume":"29","author":"Duong","year":"2020","journal-title":"Eur J Cancer Care"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1177\/109019817400200403","article-title":"Historical origins of the health belief model","volume":"2","author":"Rosenstock","year":"1974","journal-title":"Health Educ Monogr"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/109019818401100101","article-title":"The health belief model: a decade later","volume":"11","author":"Janz","year":"1984","journal-title":"Health Educ Q"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1177\/109019818801500203","article-title":"Social learning theory and the health belief model","volume":"15","author":"Rosenstock","year":"1988","journal-title":"Health Educ Q"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1097\/00002820-200605000-00012","article-title":"Psychosocial factors related to repeat mammography screening over 5 years in African American women","volume":"29","author":"Russell","year":"2006","journal-title":"Cancer Nurs"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/S0361-090X(03)00133-8","article-title":"Health beliefs, salience of breast cancer family history, and involvement with breast cancer issues: adherence to annual mammography screening recommendations","volume":"27","author":"Finney Rutten","year":"2003","journal-title":"Cancer Detect Prev"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e028705","DOI":"10.1136\/bmjopen-2018-028705","article-title":"Factors associated with breast cancer screening participation among women in mainland China: a systematic review","volume":"9","author":"Wu","year":"2019","journal-title":"BMJ Open"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2948","DOI":"10.1111\/jocn.15802","article-title":"The role of health beliefs in affecting patients' chronic diabetic complication screening: a path analysis based on the health belief model","volume":"30","author":"Jiang","year":"2021","journal-title":"J Clin Nurs"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1080\/10410236.2013.873363","article-title":"The health belief model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation","volume":"30","author":"Jones","year":"2015","journal-title":"Health Commun"},{"key":"ref24","first-page":"51","article-title":"Analysis of breast cancer screening status among women aged 35\u201364 years in Guangdong Province in 2021","volume":"34","author":"Wu","year":"2023","journal-title":"Chin J Woman Child Health Res."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1089\/154099903321667618","article-title":"Differences in perceptions of risk, benefits, and barriers by stage of mammography adoption","volume":"12","author":"Champion","year":"2003","journal-title":"J Womens Health (Larchmt)"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1002\/nur.20088","article-title":"Development of a self-efficacy scale for mammography","volume":"28","author":"Champion","year":"2005","journal-title":"Res Nurs Health"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2865","DOI":"10.31557\/APJCP.2019.20.9.2865","article-title":"Validity and reliability of health belief model questionnaire for promoting breast self-examination and screening mammogram for early cancer detection","volume":"20","author":"Che Mohamed","year":"2019","journal-title":"Asian Pac J Cancer Prev"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e0331279","DOI":"10.1371\/journal.pone.0331279","article-title":"Psychometric validation of a culturally adapted health belief model scale for breast cancer screening in Chinese women","volume":"20","author":"Liao","year":"2025","journal-title":"PLoS One"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1007\/s11747-014-0403-8","article-title":"A new criterion for assessing discriminant validity in variance-based structural equation modeling","volume":"43","author":"Henseler","year":"2015","journal-title":"J Acad Mark Sci"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/2377960820940551","article-title":"The revised Champion's health belief model scale: predictive validity among Brazilian women","volume":"6","author":"Moreira","year":"2020","journal-title":"SAGE Open Nurs"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"6103","DOI":"10.3390\/ijerph19106103","article-title":"Factors associated with screening mammogram uptake among women attending an urban university primary care clinic in Malaysia","volume":"19","author":"Abdullah","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"245","DOI":"10.32768\/abc.2024113245-254","article-title":"Predicting breast self-examination practices among Catholic nuns in Tanzania's Lake zone: a health belief model approach","volume":"11","author":"Marandu","year":"2024","journal-title":"Arch Breast Cancer"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"29854","DOI":"10.1038\/s41598-025-15478-8","article-title":"Knowledge, attitude, and practice among non-breast cancer women towards breast cancer screening with a focus on economic factors","volume":"15","author":"Zhou","year":"2025","journal-title":"Sci Rep"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2150","DOI":"10.1158\/1055-9965.EPI-25-0896","article-title":"Associations between insurance status, financial hardship, and rurality on receipt of guideline-concordant mammography","volume":"34","author":"Caston","year":"2025","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1093\/heapol\/czac104","article-title":"Barriers to cervical cancer and breast cancer screening uptake in low- and middle-income countries: a systematic review","volume":"38","author":"Srinath","year":"2023","journal-title":"Health Policy Plan"},{"key":"ref36","author":"McNeill","year":"2004"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.ypmed.2016.09.034","article-title":"Impact of provider-patient communication on cancer screening adherence: a systematic review","volume":"93","author":"Peterson","year":"2016","journal-title":"Prev Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1158\/1055-9965.EPI-11-0915","article-title":"Workplace-based breast cancer screening intervention in China","volume":"21","author":"Ma","year":"2012","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e40674","DOI":"10.7759\/cureus.40674","article-title":"From awareness to action: a review of efforts to reduce disparities in breast cancer screening","volume":"15","author":"Nayyar","year":"2023","journal-title":"Cureus"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e72533","DOI":"10.1002\/hsr2.72533","article-title":"Determinants of breast cancer screening uptake among women in northern Iran: a cross-sectional analysis of health beliefs and health literacy","volume":"9","author":"Hosseini","year":"2026","journal-title":"Health Sci Rep"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"119","DOI":"10.4103\/jehp.jehp_339_20","article-title":"Determinants of mammography screening in Tehranian women in 2018 based on the health belief model: a cross-sectional study","volume":"10","author":"Rezaeimanesh","year":"2021","journal-title":"J Educ Health Promot"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"19","DOI":"10.22201\/fpsi.20074719e.2022.1.398","article-title":"Mammography stages adoption and health beliefs in Mexican women","volume":"12","author":"Valenciano-Salas","year":"2022","journal-title":"Acta Investig Psicol"},{"key":"ref43","volume-title":"Health Status of Shenzhen Residents","year":"2025"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"2096","DOI":"10.1158\/1055-9965.2096.13.12","article-title":"A prospective study of perceived susceptibility to breast cancer and nonadherence to mammography screening guidelines in African American and white women ages 40 to 79 years","volume":"13","author":"Calvocoressi","year":"2004","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1038\/bjc.2017.107","article-title":"Cumulative risk of breast cancer screening outcomes according to the presence of previous benign breast disease and family history of breast cancer: supporting personalised screening","volume":"116","author":"Rom\u00e1n","year":"2017","journal-title":"Br J Cancer"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"10119","DOI":"10.1007\/s00432-023-04905-w","article-title":"Evaluation of a population-based breast cancer screening in North China","volume":"149","author":"Wu","year":"2023","journal-title":"J Cancer Res Clin Oncol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"02001","DOI":"10.1051\/shsconf\/202315202001","article-title":"Women\u2019s education in China: past and present","volume":"152","author":"Lu","year":"2023","journal-title":"SHS Web Conf"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1007\/s11150-024-09747-0","article-title":"Returns to women\u2019s education within marriage: evidence from a regression discontinuity design study in China","volume":"24","author":"Wang","year":"2026","journal-title":"Rev Econ Household"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1936136\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T07:53:30Z","timestamp":1790754810000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1936136\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":48,"alternative-id":["10.3389\/fpubh.2026.1936136"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1936136","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1936136"}}