Integrating Pros and Cons for Mammography and Pap Testing: Extending the Construct of Decisional Balance to Two Behaviors

Background. The ability to study health-related behaviors in combination rather than singly will lead to a more comprehensive approach to health promotion. This investigation focused on mammography and Pap testing. One index was created to reflect the recency of receiving both examinations. A second index integrated opinions about the two procedures into a single measure, guided by the pros, cons, and decisional balance constructs of the Transtheoretical Model of behavior change. Method. Data were drawn from the baseline and 1-year follow-up surveys of an HMO sample of women ages 40–74 ( N = 1,605). Data collection occurred by telephone. A series of analyses examined whether recency of screening was associated with opinions about screening. Results. The first analysis showed that recency of Pap testing and whether or not a Pap test was obtained between the two surveys were associated with opinions about Pap testing. The next analysis examined the association between the indicator for regularity of both Pap testing and mammography, with the measure of opinions toward the two procedures. The variable measuring receipt of Pap test and mammography was associated with the combined measure of opinions. Conclusions. The ability to employ combined indicators for recency of testing and test-related opinions is promising for being able to take a more comprehensive approach to women's health. The paper discusses methodological considerations that arise when attempting to integrate two or more behaviors.