Academic journal article Journal of School Health

Effects of a Brief Theory-Based Intervention on the Practice of Testicular Self-Examination by High School Males

Academic journal article Journal of School Health

Effects of a Brief Theory-Based Intervention on the Practice of Testicular Self-Examination by High School Males

Article excerpt

Testicular cancer is the most common form of cancer among males ages 15-40 and a leading cause of death in this age group. (1-3) Successful treatment of testicular cancer depends on early detection of the disease before it spreads beyond the testes to other body parts. (4) The American Cancer Society (5) recommends that testicular self-examination (TSE), a simple procedure designed to facilitate early detection, be performed monthly by males beginning at age 15. Unfortunately, most young men are unaware of their risk for testicular cancer and are unfamiliar with TSE. (6) For example, a recent survey (7) of ninth grade boys revealed that 72% had never heard of testicular cancer, 87% had never heard of TSE, and none knew how to perform the exam.

This preliminary study evaluated a program designed to teach high school students about testicular cancer and the TSE procedure and to encourage them to perform the exam once a month. The conceptual framework for the program was provided by the theory of planned behavior, (8) a recent revision of the theory of reasoned action. (9) The theory of planned behavior suggests that performance of a behavior, such as TSE, results from a person's reasoned intention to perform or not perform the behavior.

Behavioral intention, in turn, is a function of the individual's attitude toward the behavior, his or her perception of whether generalized significant others would or would not approve (referred to as subjective norm), and his or her perceived control over the target behavior. The theory further suggests that attitude toward the behavior reflects beliefs about outcomes of performing the behavior, weighted by the value attached to each outcome. Subjective norm is determined by beliefs about the wishes of significant groups or individuals (Figure 1).


The theory posits that to change behavior, it is necessary to modify the outcome, normative, and/or control beliefs that underlie the behavior. To encourage the practice of TSE, it would be necessary to establish beliefs that performing TSE will lead to valued outcomes, that significant others would want the individual to perform the exam, and that the individual has the ability to perform the exam successfully.

The theories of reasoned action and planned behavior have received considerable empirical support as means of predicting and explaining a variety of health-related behaviors, including TSE. Brubaker and Wickersham (10) found that performance of TSE by college students over a six-week period related significantly to attitude toward the behavior, subjective norm, and perceived control, and that those who performed the exam differed significantly from those who did not in terms of outcome and normative beliefs. In addition, Brubaker and Fowler (11) reported that college students exposed to a persuasive message based on the theoretical model, such as a message designed to challenge unfavorable beliefs about the outcomes of performing TSE as well as strengthen favorable beliefs, were twice as likely as students not exposed to the message to have performed the exam over a four-week period.

The theory of planned behavior holds promise as a foundation for designing effective interventions to promote TSE by college students. This framework has not yet been used to guide development of a TSE intervention aimed at high school males. Considering the recommendation that monthly TSE begin at age 15, (5) high school males seem to be an appropriate target group.

A study by Vaz et al (12) reported that a 50-minute, one-session intervention was successful at increasing ninth grade boys' awareness of testicular cancer as well as their knowledge and practice of TSE. Unfortunately, the Vaz et al study was not based on any theoretical model and, as a consequence, provides little insight into the specific mechanisms by which the students' behavior was changed. This study evaluated a brief, theory-based intervention designed to encourage the practice of TSE by high school students by creating a favorable attitude toward TSE, a perception of social pressure to perform TSE, and a sense of control over the behavior. …

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