To reduce deaths due to nose and throat cancer, also known as nasopharyngeal cancer (NPC), it is important to understand factors that motivate the public to undertake cancer screening. This study employed the risk perception attitude (RPA) framework to predict factors influencing NPC risk-reducing behaviors among a group of Malaysians. A sample of Malaysians (n=215) completed a questionnaire about perceived susceptibility, perceived severity, self-efficacy, response efficacy, and intention to enact self-protective actions to reduce NPC risk. A majority of the participants had responsive (high risk, high efficacy) and proactive attitudes (low risk, high efficacy). Hierarchical regression of mediation effect under structural equation model (SEM) approach was used to test the theory. Response efficacy and self-efficacy were negatively associated with perceived risk (p<0.01). Intention was negatively associated with perceived risk and positively associated with response efficacy and self-efficacy (p<0.01). Heightened perceived risk weakens efficacy beliefs and intention to enact self-protective behavior, suggesting that low-risk messages may work better to avert fatalistic thinking for this group. Perceived risk and response efficacy explained 26.5% of the variance in self-efficacy, suggesting the importance of framing NPC risk messages to heighten the audience’s confidence to enact self-protective health behaviors.
Keywords: Nasopharyngeal cancer, Risk Perception Attitude framework, risk-reducing behaviors, MalaysiansAdham, M., Kurniawan, A. N., Muhtadi, A. I., Roezin, A., Hermani, B., Gondhowiardjo, S., Tan, B., & Middeldorp, J. M. (2012). Nasopharyngeal carcinoma in Indonesia: Epidemiology, incidence, signs, and symptoms at presentation. Chinese Journal of Cancer, 31(4), 185–196. doi: 10.5732/cjc.011.10328
Allo, T. A., Edewor, P. A., & Imhonopi, D. (2019). Assessment of perceived risks of breast cancer and breast cancer screening among women in five selected local governments in Ogun State, Nigeria. SAGE Open, 9(2),1–11. https://doi.org/10.1177/2158244019841924
Armstrong, R. W., Imrey, P. B., Lye, M. S., Armstrong, M. J., Yu, M. C., & Sani, S. (1998). Nasopharyngeal carcinoma in Malaysian Chinese: Salted fish and other dietary exposures. International Journal of Cancer, 77(2), 228–235. https://doi.org/10.1002/(SICI)1097-0215(19980717)77:2<228::AID-IJC11>3.0.CO;2-7
Armstrong, R. W., Kutty, M. K., & Armstrong, M. J. (1978). Self-specific environments associated with nasopharyngeal carcinoma in Selangor, Malaysia. Social Science & Medicine. Part D: Medical Geography, 12(3-4), 149–156. https://doi.org/10.1016/0160-8002(78)90029-1
Armstrong, R. W., Armstrong, M. J., & Lye, M. S. (2000). Social impact of nasopharyngeal carcinoma on Chinese households in Selangor, Malaysia. Singapore Medical Journal, 41(12), 582–587.
Aziz, A., Ramli, R. R., Mohamad, I., & Bhavaraju, V. M. K. (2017). Young nasopharyngeal carcinoma: A review of an 8-year experience in the East Coast Malaysia Hospital. The Egyptian Journal of Otolaryngology, 33(2), 490–494.
Balachandran, R., Philip, R., Avatar, S., Simon, R., Mann, G. S., Benedict, C. T. W., Chong, A., & Ch’ng, M. L. (2012). Exploring the knowledge of nasopharyngeal carcinoma among medical doctors at primary health care level in Perak state, Malaysia. European Archives of Oto-Rhino-Laryngology, 269(2), 649–658.
Banning, M., & Hafeez, H. (2010). A two-center study of Muslim women`s views of breast cancer and breast health practices in Pakistan and the UK. Journal of Cancer Education, 25, 349–353.
Bell, R. A., McGlone, M. S., & Dragojevic, M. (2014). Bacteria as bullies: Effects of linguistic agency assignment in health message. Journal of Health Communication, 19(3), 340–358. https://doi.org/10.1080/10810730.2013.798383
Chang, E. T., & Adami, H. O. (2006). The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiology and Prevention Biomarkers, 15(10), 1765–1777. doi: 10.1158/1055-9965.EPI-06-0353
Chen, L. S., & Kaphingst, K. A. (2011). Risk perceptions and family history of lung cancer: Differences by smoking status. Public Health Genomics, 14(1), 26–34. https://doi.org/10.1159/000294151
Cheung, S. T., Lo, K. W., Leung, S. F., Chan, W. Y., Choi, P. H., Johnson, P. J., Lee, J. C., & Huang, D. P. (1996). Prevalence of LMP1 deletion variant of Epstein‐Barr virus in nasopharyngeal carcinoma and gastric tumors in Hong Kong. International Journal of Cancer, 66(5), 711–712. https://doi.org/10.1002/(SICI)1097-0215(19960529)66:5<711::AID-IJC21>3.0.CO;2-5
Chow, W. S., & Chan, L. S. (2008). Social network, social trust and shared goals in organizational knowledge sharing. Information & Management, 45(7), 458–465. https://doi.org/10.1016/j.vaccine.2010.03.027
Chua, M. L. K., Wee, J. T. S., Hui, E. P., & Chan, A. T. C. (2016). Nasopharyngeal carcinoma. Lancet, 387(10022), 1012–1024. https://doi.org/10.1016/S0140-6736(15)00055-0
Devi, B. C., Pisani, P., Tang, T. S., & Parkin, D. M. (2005). High incidence of nasopharyngeal carcinoma in native people of Sarawak, Borneo Island. Cancer Epidemiol Biomarkers Prev. 13(3), 482–486.
Fles R., Wildeman M. A., & Sulistiono B. (2010). Knowledge of general practitioners about nasopharyngeal cancer at the Puskesmas in Yogyakarta, Indonesia. BMC Medical Education, 10, Article 81. doi: 10.1186/1472-6920-10-81.
Fles, R., Indrasari, S. R., Herdini C., Martini, S., Isfandiari, A., Romdhoni, A. C., Adham, M., Mayangsari, I. D., van Werkhoven, E., Wildeman, M. A., Hariwiyanto, B., Hermani, B., Kentjono, W. A., Haryana, S. M., Schmidt, M. K., & Tan, B. (2016). Effectiveness of a multicenter nasopharyngeal carcinoma awareness programme in Indonesia. BMJ Open, 6, Article 4008571. doi:10.1136/bmjopen-2015-008571
Ghani, W. M. N., Doss, J. G., Jamaluddin, M., Kamaruzaman, D., & Zain, R. B. (2013). Oral cancer awareness and its determinants among a selected Malaysian population. Asian Pacific Journal of Cancer Prevention, 14(3), 1957–1963.
Grasso, K. L., & Bell, R. A. (2015). Understanding health information seeking: A test of the risk perception attitude framework. Journal of Health Communication, 20(12), 1406–1414. https://doi.org/10.1080/10810730.2015.1018634
Hadi, M. A., Hassali, M. A., Shafie, A. A., & Awaisu, A. (2010). Evaluation of breast cancer awareness among female university students in Malaysia. Pharmacy Practice, 8(1), 29–34.
Hair, J. F., Black, W. C., & Babin, B. J. (2010). Multivariate data analysis. Pearson Prentice Hall.
Hanoch, Y., Rolison, J. J., & Freund, A. M. (2016). Does medical risk perception and risk taking with age? Society for Risk Analysis, 38(5), 917–928. https://doi.org/10.1111/risa.12692
Katapodi, M. C., Lee, K. A., Facione, N. C., & Dodd, M. (2004). Predictors of perceived breast cancer risk and the relation between perceived risk and breast cancer screening: A meta-analytic review. Preventive Medicine, 38, 388–402. https://doi.org/10.1016/j.ypmed.2003.11.012
Khoo, C. L., Teoh, S., Rashid, A. K., Zakaria, U. U., Mansor, S., Salleh, F. N. M., & Nawi, M. N. M. (2011). Awareness of cervical cancer and HPV vaccination and its affordability among rural folks in Penang Malaysia. Asian Pacific Journal of Cancer Prevention, 12(6), 1429–1433.
Leshner, G., I-Huei, C., Hyun, J. S., Yoon, Y. C., & Frisby, C. (2006). The role of spiritual health locus of control in breast cancer information processing between African American and Causian women. Integrative Medicine Insights, 2(2), 35–44. https://doi.org/10.1177/117863370600100004
Mahdavifar, N., Ghoncheh, M., Mohammadian-Hafshejani, A., Khosravi, B., & Salehiniya, H. (2016). Epidemiology and inequality in the incidence and mortality of nasopharynx cancer in Asia. Osong Public Health Res Perspect, 7(6), 360–372. https://doi.org/10.1016/j.phrp.2016.11.002
Ministry of Health, Malaysia. (2015). Malaysian national cancer registry report: 2007–2011 Malaysia cancer statistics, data and figure. National Cancer Institute.
Ministry of Health, Malaysia. (2017). Summary of Malaysian national cancer registry report 2007-2011. National Cancer Registry Department and National Cancer Institute.
Morris, N. S., Field, T. S., Wagner, J. L., Cutrona, S. L., Roblin, D. W., Gaglio, B., Williams, A. E., Han, P. J. K., Costanza, M. E., & Mazor, K. M. (2013). The association between health literacy and cancer-related attitudes, behaviors, and knowledge. Journal of Health Communication, 18(Sup1), 223–241. https://doi.org/10.1080/10810730.2013.825667
Norlaili, A. A., Fatihah, M. A., Daliana, N. F. N., & Maznah, D. (2013). Breast cancer awareness of rural women in Malaysia: Is it the same as in the cities? Asian Pacific Journal of Cancer Prevention, 14(12), 7161–7164.
Nunnally, J. C. Bernstein, I. H. (1994). Psychometric theory. McGraw-Hill.
O’Callaghan, C., Schofield, P., Butow, P., Nolte, L., Price, M., Tsintziras, S., Sze, M., Thein, T., Yiu, D., Mireskandari, S., Goldstein, D., & Jefford, M. (2016). “I might not have cancer if you didn’t mention it”: A qualitative study on information needed by culturally diverse cancer survivors. Supportive Care in Cancer, 24(1), 409–418.
Parkin, D. M., Bray, F., & Ferlay, J. (2002). Global cancer statistics: 2002. CA: A Cancer Journal for Clinicians, 55(2), 74–108. https://doi.org/10.3322/canjclin.55.2.74
Peters, E., Dieckmann, N,. Dixon, A., Hibbard, J. H., & Mertz, C. K. (2007). Less is more in presenting quality information to consumers. Medical Care Research and Review, 64(2), 169–190. https://doi.org/10.1177/10775587070640020301
Prasad, U., & Rampal, L. (1992). Descriptive epidemiology of nasopharyngeal carcinoma in Peninsular Malaysia. Cancer Causes & Control, 3(2), 179–182.
Rahman, S., Subroto, H., & Novianti, D. (2013, June 1-5). Clinical presentation of nasopharyngeal carcinoma in West Sumatra, Indonesia. Paper presented at the 20th World Congress of IFOS, Seoul, Korea.
Rimal, R. N. (2000). Closing the knowledge-behavior gap in health promotion: The mediating role of self-efficacy. Health Communication, 12, 219–237. https://doi.org/10.1207/S15327027HC1203_01
Rimal, R. N., & Juon, H-S. (2010). Use of the risk perception attitude framework for promoting breast cancer prevention. Journal of Applied Social Psychology, 40(2), 287–310. https://doi.org/10.1111/j.1559-1816.2009.00574.x
Rimal, R. N., & Real, K. (2003). Perceived risk and efficacy beliefs as motivators of change: Use of the risk perception attitude (RPA) framework to understand health behaviors. Human Communication Research 29(3), 370–399. https://doi.org/10.1111/j.1468-2958.2003.tb00844.x
Rimal, R. N., Böse, K., Brown, J., Mkandawire, G., & Folda, L. (2009). Extending the purview of the risk perception attitude framework: Findings from HIV/AIDS prevention research in Malawi. Health Communication, 24(3), 210–218. https://doi.org/10.1080/10410230902804109
Samat, N., Ghazali, S., & Atang, C. (2014). Awareness and knowledge of cancer: a community survey in Kedah and Perlis. Asian Social Science, 10(21), 10–18.
Sekaran, U., & Bougie, R. (2010). Research methods for business: A skill building approach. Wiley.
Su, T. T., Goh, J. Y., & Tan, J., Muhaimah, A. R., Pigeneswaren, Y., Khairun, N. S., Normazidah, A. W., Tharisini, D. K., & Majid, H. A. (2013). Level of colorectal cancer awareness: A cross sectional exploratory study among multi-ethnic rural populations in Malaysia. BMC Cancer, 13(1), 1–8.
Sullivan, H. W., Beckjord, E. B., Rutten, L. J. F., & Hesse, B. W. (2008). Nutrition-related cancer prevention, cognitions and behavioral intentions: Testing the risk perception attitude framework. Health Education & Behavior, 35(6), 866–879. https://doi.org/10.1177/1090198108326164
Tarone, R. E., Levine, P. H., Yadav, M., & Pandey, J. P. (1990). Relationship between immunoglobulin allotypes and susceptibility to nasopharyngeal carcinoma in Malaysia. Cancer Research, 50(11), 3186–3188.
Teoh, J. W., Yunus, R. M., Hassan, F., Ghazali, N., & Abidin, Z. A. (2014). Nasopharyngeal carcinoma in dermatomyositis patients: A 10-year retrospective review in Hospital Selayang, Malaysia. Reports of Practical Oncology & Radiotherapy, 19(5), 332–336.
Thompson, R., Barclay, D., & Higgins, C. A. (1995). The partial least squares (PLS) approach to causal modeling: Personal computer adoption and use as an illustration. Technology Studies, 2(2), 285–309.
Ting, S. H., Jerome, C., Podin, Y., & Wan Ahmad, S. S. (2018, November 4–5). Evaluating nose and throat cancer risk: Number sense and taboos on ill-health. Paper presented at the 2nd International Conference on Social and Economic Development (ICSED2) 2018, Kuala Terengganu, Malaysia.
Tiong, T. S., & Selva, K. S. (2005). Clinical presentation of nasopharyngeal carcinoma in Sarawak Malaysia. Medical Journal of Malaysia, 60(5), 624–628.
Tse, L. A., Yu, I. T., Mang, O. W., & Wong, S. L. (2006). Incidence rate trends of histological subtypes of nasopharyngeal carcinoma in Hong Kong. British Journal of Cancer, 95(9), 1269–1273.
Wee, J., Ha, T. C., Loong, S., & Qian, C. (2010). Is nasopharyngeal cancer really a “Cantonese cancer”? Chinese Journal of Cancer, 29(5), 517–526.
Witte, K. (1994). Fear control and danger control: A test of the extended parallel process model (EPPM). Communication Monographs, 61, 113–134. https://doi.org/10.1080/03637759409376328
Wong, C. H. (2009). Investigating the effects of cancer risk and efficacy perceptions on cancer prevention adherence and intentions. Health Communication, 24(2), 95–105.
Wong, C. H. (2012). Interaction of comparative cancer risk and cancer efficacy perceptions on cancer-related information seeking and scanning behaviors. Communication Research Reports, 29(3), 193–203. https://doi.org/10.1080/08824096.2012.684808
Wong, L. P., Wong, Y. L., Low, W. Y., Khoo, E. M., & Shuib, R. (2009). Knowledge and awareness of cervical cancer and screening among Malaysian women who have never had a Pap smear: A qualitative study. Singapore Medical Journal, 50(1), 49–53.
Yu, M. C., Ho, J. H., Lai, S. H., & Henderson, B. E. (1986). Cantonese-style salted fish as a cause of nasopharyngeal carcinoma: Report of a case-control study in Hong Kong. Cancer Research, 46(2), 956–961.
Yu, Z. H., Xu, G. Z., Hu, Y. H., Su, X. G., & Gu, X. Z. (1985). Value of computed tomography in staging the primary lesion (T-staging) of nasopharyngeal carcinoma (NPC): An analysis of 54 patients with special reference to the parapharyngeal space. International Journal of Radiation Oncology, Biology, Physics, 11(12), 2143–2147. https://doi.org/10.1016/0360-3016(85)90095-1
Zafar, S. Y., Peppercorn, J. M., Schrag, D., Taylor, D. H., Goetzinger, A. M., Zhong, X., & Abernethy, A. P. (2013). The financial toxicity of cancer treatment: A pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. The Oncologist, 18(4), 381–390. https://doi.org/10.1634/theoncologist.2012-0279