Can the theory of planned behaviour help explain follow-up attendance of childhood cancer survivors?

Abstract

Background: Childhood cancer survivors are at high risk for late effects. Regular attendance to long-term follow-up care is crucial and helps monitoring survivors’ health. The Theory of Planned Behaviour (TPB) was developed to predict a diverse range of health behaviours. We investigated whether the TPB helps explain attendance to follow-up care in Swiss survivors. We aimed to i) identify TPB-related predictors for the intention to attend follow-up, and ii) examine associations between intention and actual attendance. Methods: We sent a questionnaire to 716 eligible Swiss childhood cancer survivors (diagnosed with cancer aged <16 years; ≥5 years since diagnosis; aged 18 - 40 years at study). We assessed TPB-related predictors (attitude, subjective norm, perceived control), intention to attend follow-up care, and actual attendance. We applied structural equation modelling to investigate predictors of intention and logistic regression models to study the association between the intention and actual attendance. Findings: Of 299 responders (41.8%; 166 females (55.5%)), 145 (48.5%) reported attending follow-up care. We found that subjective norm (Coef.0.89, p<0.001) predicted the intention to attend follow-up, while attitude and perceived control did not. Perceived control (OR=1.3, 95%CI:1.03–1.71) and the intention to attend follow-up (OR=2.0, 95%CI:1.70–2.32) were positively associated with attendance. Discussion: Interventions to promote positive subjective norm and enhance perceived control are needed to increase attendance to follow-up care. Educating survivors on different models for follow-up care may enhance perceived control. Parents, friends, and health care professionals should be advised on the importance of their support regarding survivors’ attendance.